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UBC Theses and Dissertations

A follow-up study of family group therapy Akin, Clifford K 1966

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FOLLOW-UP STUDY OF FAMILY GROUP THERAPY The case study method was used t o follow-up eighteen families who had experienced treatment a t the Burnaby Mental Health Centre, Burnaby, B.C. from April 1, 1964 to March 31, 1965 b y CLIFFORD-RHETTA CORRINNE. A. KENNETH.L, CAROL A, JACK S. K. AKIN DLIN .J..FORST LEVITT SMITH YEE Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of .MASTER OF SOCIAL WORK in' the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work I966 The University of British Columbia I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that per-m i s s i o n f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s representatives» I t i s understood that copying or p u b l i -c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n p e r mission. Department of The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada. I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study, I f u r t h e r agree that per-m i s s i o n f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s representatives,, I t i s understood that copying or p u b l i -c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department of The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada, Date -11-TABLE OF CONTENTS Chapter I The Problem Page Areas of I n q u i r y . The Problem f o r Re s e a r c h . T h e o r e t i c a l Concepts. . P r e v i o u s R e s e a r c h . G u i d i n g Q u e s t i o n s f o r Study. V a l u e Assumptions and Assumptions of F a c t . O u t l i n e of the Study 1 Chapter I I Methodology o f the Study. L e v e l of R e s e a r c h D e s i g n . C o n t r o l of I n t e r f e r i n g V a r i a b l e s . P l a n of Data A n a l y s i s . S ampling P r o c e d u r e s . . Source of data.. D i v i s i o n of Q u e s t i o n n a i r e * .. . . 26 Chapter I I I A n a l y s i s o f the F i n d i n g s R e l i a b i l i t y Study o f Husband-Wife Task S h a r i n g R o l e s . R e l i a b i l i t y S t u d y : Husband's P a r t i c i p a t i o n Index. Q u e s t i o n n a i r e A n a l y s i s . O c c u p a t i o n and E d u c a t i o n . R o l e s . A t t i t u d e s t o S o c i a l A g e n c i e s . E x t e r n a l F a m i l y R e l a t i o n s h i p s and use of Community R e s o u r c e s . Communication. I n t r a - F a m i l i a l R e l a t i o n s h i p s . Summary of F i n d i n g s 46 Chapter IV Summary and C o n c l u s i o n s Summary of major f i n d i n g s . Summary T a b l e on G e n e r a l C h a r a c t e r i s t i c s o f a l l the changes n o t e d by the e i g h t e e n f a m i l i e s i n t e r v i e w e d . C o n c l u s i o n s . .. 108 Annotated B i b l i o g r a p h y . 121 B i b l i o g r a p h y 125 A p p e n d i c e s : I I n t r o d u c t o r y l e t t e r t o P r o s p e c t i v e Inte r v i e w e e s . . . . . 128 I I The I n t e r v i e w Schedule 129 I I I L i c h e r t S c a l e of Task S h a r i n g 135 IV T h e r a p i s t s ' I m p r e s s i o n s 137 V R e f u s a l s V l 4 l VI F a m i l y Types 143 TABLES IN THE TEXT T a b l e 1. Summary of F i n d i n g s of e i g h t e e n F a m i l i e s I n t e r v i e w e d . . 47 T a b l e 2. Frequency D i s t r i b u t i o n of Agreement S c o r e s Between Husband and Wife on C o n j u g a l R o l e R e l a t i o n s h i p s 48 T a b l e 3. T a s k - S h a r i n g Agreement as R e l a t e d t o Number of I n t e r v i e w s 49 - l i i -Page Table 4. Task-Sharing Agreement as Related to S o c i a l Class of Family 50 Table 5« Task-Sharing Agreement as Related to Th e r a p i s t s ' Impressions of Change during Treatment 5° Table 6. Task-Sharing Agreement as Related to Family Type . .7 50 Table ?. Discrepancy as Related to Number of Interviews 52 Table S. Discrepancy as Related t o . S o c i a l Class of Family 53 Table 9 . Discrepancy as Related to T h e r a p i s t s ' Impressions of Change During Treatment ...... '53 Table 10. Discrepancy as Related to Family Type 54 Table 11. Change i n Function at Work or School as Related to Number of Interviews i n Treatment. 56 Table 12. Change i n F u n c t i o n i n g at Work or School as r e l a t e d to Class 5? Table 13. Change i n Funct i o n i n g at Work and School as Related to Family Types and t h e i r Respective Interview Frequencies 58 Table 14. Change i n Frequency at Work and School as Related to number of Family Members attending Treatment 58 Table 15. Change i n Fu n c t i o n i n g at Work and School as Related to Number of Family Members Attending Treatment and Number of Interviews Attended .60 Table 16. Change i n Funct i o n i n g at Work and School as Related to T h e r a p i s t s ' Impressions of Symptom R e l i e f f o r I d e n t i f i e d P a t i e n t s 61 Table 17. Change i n Household Helping A c t i v i t y to Number of Interviews 67 Table 13. change i n Household Helping A c t i v i t y Related to Class 68 Table 19. Change i n Household Helping A c t i v i t y Related to T h e r a p i s t s ' Impressions 68 Table 20. Change i n Household Helping A c t i v i t y as Related to Family Type 69 Table 21. Respondents' Change i n Household Helping A c t i v i t y as Related to Members' Role Performances 70 Table 22. Respondents' F e e l i n g s of Change about t h e i r place In the Family 72 Table 23. Number of Interviews Related to Fathers' Change about h i s Place i n the Family ........ 72 Table 24. Father's Change i n h i s F e e l i n g s about h i s place i n the Family Related to Class 73 Table 25. A t t i t u d e s Toward the Agency i n F a m i l i e s w i t h Three or Less Interviews as Compared wi t h Those w i t h Four or more 77 Table 26. Socio-economic P o s i t i o n of F a m i l i e s w i t h P o s i t i v e A t t i t u d e s as Compared with Those wi t h Negative A t t i t u d e s 77 - i v -Page T a b l e 27. T h e r a p i s t s ' R a t i n g s o f F a m i l i e s w i t h P o s i t i v e A t t i t u d e s a s Compared w i t h T h o s e w i t h N e g a t i v e A t t i t u d e 78 T a b l e 28. Improvement i n O t h e r A r e a s a s R e l a t e d t o Agency A t t i t u d e s 79 T a b l e 29.. F a m i l y T y p e s and Change i n C o m m u n i c a t i o n ... 96 T a b l e 30 . Number o f I n t e r v i e w s and Change i n C o m m u n i c a t i o n f . . . . 97 T a b l e 31 . S o c i o - e c o n o m i c L e v e l and Change i n C o m m u n i c a t i o n 98 T a b l e 32 . Change i n I n t r a - F a m i l i a l R e l a t i o n s h i p as R e l a t e d t o S o c i o - e c o n o m i c S t a t u s 105 T a b l e 3 3 . Change i n I n t r a - F a m i l i a l R e l a t i o n s h i p s as R e l a t e d t o Number o f I n t e r v i e w s 105 T a b l e 34. Change i n I n t r a - F a m i l i a l R e l a t i o n s h i p s a s R e l a t e d t o Number o f I n t e r v i e w s 106 T a b l e 35. Change i n I n t r a - F a m i l i a l R e l a t i o n s h i p s a s R e l a t e d t o F a m i l y Type 106 T a b l e 36. The G e n e r a l C h a r a c t e r i s t i c s o f the E i g h t e e n F a m i l i e s I n t e r v i e w e d , as t o S o c i o - B c o n o m i c L e v e l , Number o f I n t e r v i e w s , T h e r a p i s t s " R a t i n g s j and a s t o t h e Changes R e c o r d e d i n E a c h A r e a o f o u r Q u e s t i o n n a i r e 110 T a b l e 37* S o c i o - E c o n o m i c L e v e l o f F a m i l i e s as i t i s r e l a t e d t o Change i n S i x A r e a s o f F a m i l y F u n c t i o n i n g I l l T a b l e 38 . T h e r a p i s t s ' I m p r e s s i o n s o f Improvement as i t i s R e l a t e d t o Cnange i n S i x a r e a s o f F a m i l y F u n c t i o n i n g I l l T a b l e 39. The Number o f I n t e r v i e w s as r e l a t e d t o change i n S i x a r e a s o f F a m i l y F u n c t i o n i n g .. 112 T a b l e ko. Number o f f a m i l i e s i n e a c h t y p e r e p o r t i n g c h a n g e s . i n e a c h a r e a o f f a m i l y f u n c t i o n i n g . . 112 TABLES IN THE APPENDICES T a b l e 1. The number o f I n t e r v i e w s P a r t i c i p a t e d i n by F a m i l i e s i n t e r v i e w e d i n o u r F o l l o w - u p i n t e r v i e w s compared w i t h f a m i l i e s who r e f u s e d t o be i n t e r v i e w e d l 4 l T a b l e 2. The T h e r a p i s t s ' r a t i n g s o f t h e outcome o f T h e r a p y i n C a s e s w h i c h s u b s e q u e n t l y r e f u s e d compared w i t h t h o s e who a c c e p t e d f o r a f o l l o w - u p i n t e r v i e w . - . . Ik2 T a b l e 3« T y p e s o f f a m i l i e s i n t e r v i e w e d i n . f o l l o w - u p as compared w i t h t h o s e who r e f u s e d t o be i n t e r v i e w e d 142 ABSTRACT Family Group Therapy has in the past ten years gained much notice in the f i e l d of Mental Health,especially in the treatment of children. However, despite the fact that much family group therapy has been done,little research into the results or lasting effects has been carried on. This study hoped to explore some of the effects of family group therapy on a particular group of families from which a random sample was taken . They were seen at the Burnaby Mental Health Centre, over a period of one year. In. family group therapy the approach is radically different from that of individual therapy with an Identified patient. The whole family is seen together with an emphasis on total family functioning. Therefore, in our follow-up study we designed our questionnaires and data analysis to include the entire family equally with no emphasis on any particular member. In designing our questionnaire we chose the six areas of family functioning considered most important, both by the therapists and the theorists, in the f i e l d of family group, therapy. In each of these areas changes in the families 1 perception of their own functioning was elicited.. To determine the r e l i a b i l i t y of our results a r e l i a b i l i t y test originally designed by Kerckhoft was used in the areas of husband-wife task sharing and role relationships. We then compared'the results of our questionnaire and Kerckhoft r e l i a b i l i t y test with four independent variables. These variables including socio-economic class, family type, number of interviews, and therapists' impressions. In. two variables particularly, the socio-economic class and the number of interviews, we found a relationship between the results of our questionnaire and the variables. We experienced d i f f i c u l t i e s in obtaining a suitable sample to interview. Only eighteen, families agreed to be interviewed for the purposes of this study, from a total of fifty-four families contacted. For that reason a superficial study is also done of those families who refused to be interviewed. - v i -As our sample was found to be not r e a l l y representative of a l l families seen i n family group therapy i t i s rather premature to draw any r e a l conclusions from our study. However, i t i s possible to say that family group therapy did seem to e f f e c t changes i n a number of the families interviewed. - v i i -ACKNOWLEDQEMBNTS Through the good o f f i c e s of the agency D i r e c t o r , Dr. Kenneth Davies, and the Supervisor of S o c i a l S e r v i c e , Mr. Donald R i c k e t t s , the f u l l resources of the Burnaby Mental Health Centre were made a v a i l a b l e to t h i s research p r o j e c t . Arrangements were made so that we were given f u l l access to any f i l e i n f o r m a t i o n we.needed. Dr. K. Davies and Mr. D. R i c k e t t s were of f u r t h e r a s s i s t -ance to the researchers by sending a l e t t e r to our whole sample n o t i f y i n g the f a m i l i e s that they would be contacted. Many of the s t a f f , both p r o f e s s i o n a l and c l e r i c a l , d i s p l a y e d a concern about and i n t e r e s t i n the goals and method of t h i s p r o j e c t . The s t a f f not only co-operated f u l l y and w i l l i n g l y , but o f f e r e d many u s e f u l suggestions which were subsequently incorporated i n the study. S p e c i a l g r a t i t u d e i s hereby expressed to Dr. Richard Davis, Mr. Angelo Tessaro,. and Mr. Sonny Zimmerman, the t h e r a p i s t s from whose caseload we drew our f u l l sample, and without whose co-operation the study could not have taken place. They a l s o c o n t r i b u t e d t h e i r time In supplying us with t h e i r impressions on a l l the cases we studied. Mrs. V i v i a n E l l i s . Casework Supervisor at the Burnaby Mental Health Centre, who i s In the process of conducting a l o n g i t u d i n a l study of f a m i l i e s seen by the same t h e r a p i s t s , gave the researchers her added support. We would a l s o l i k e to express our g r a t i t u d e to Miss Margaret Towers, P u b l i c Health Nurse on the f a m i l y group therapy team, f o r her work i n gathering together the names which made up our sample and to Mr. Robert McCallum, Burnaby Mental Health Centre Business Manager f o r h i s co-operation. We would a l s o l i k e to acknowledge the s p e c i a l i n t e r e s t and co-operation expressed i n our p r o j e c t by the Intake Team of the Children's C l i n i c at the Burnaby Mental Health Centre. - v i i i -We a l s o acknowledge.the eighteen families who gave of t h e i r time to. take part in this study. Our thanks go out to the researchers' supervisor of studies, Dr. John Crane, whose knowledge of the subject, advice, and support we gratefully appreciated. F i n a l l y , a special thanks to G i l l i a n Akin for her patience and d i l i g e n c e i n t y p i n g the f i r s t and f i n a l drafts of our thesis. CHAPTER I THE PROBLEM Areas of Inquiry. A review of the l i t e r a t u r e on family group therapy indicates that very l i t t l e research has been carried on t h e o r e t i c a l l y or p r a c t i c a l l y . 1 F i r s t , there i s a lack of systematized surveys investigating the general v a l i d i t y of family group therapy as a treatment process ( i . e . follow-up studies, comparative studies, e t c . ) . In other words the question remains - does family group therapy In fact a t t a i n the treatment goals or aims which i t s theorists and p r a c t i -tioners e s t a b l i s h f o r this approach? Secondly, what are the immediate or long term re s u l t s i n family behaviour produced on the part of the therapist? I f there are immediate changes noticeable, are the changes of any r e a l or permanent s i g n i f -icance? 2 In other words, to what degree can changes be effected, for how long? In addition, what happens to other members of the family when one member Improves or when the family homeostasis i s upset?3 The investigation of more s p e c i f i c questions could help the p r a c t i t i o n e r i n treatment planning. For example, Hleakland, John H. "Family Therapy as a Research Arena," Family Process, Vol. 1 , No. 1 , March, 1 9 6 2 , pp.63-68. 2 I b i d . , p. 6 8 . 3 l b i d . , p. 6 8 . - 2 -a r e t h e r e c e r t a i n i n s t a n c e s i n w h i c h f a m i l y g r o u p t h e r a p y c a n be u s e d i n v a r i o u s c o m b i n a t i o n s w i t h o t h e r f o r m s o f t r e a t m e n t , s u c h a s m i l i e u t h e r a p y , I n d i v i d u a l t r e a t m e n t , p l a y t h e r a p y , m u l t i p l e i m p a c t t h e r a p y , and so f o r t h ? A n o t h e r way o f e x a m i n i n g t r e a t m e n t c o m b i n a t i o n s w o u l d be t o d e t e r m i n e t h e d e s i r a b i l i t y o f h a v i n g t h e p a r e n t s r e m a i n i n t r e a t m e n t a f t e r t h e c h i l d t e r m i n a t e s o r v i c e v e r s a . I n r e l a t i o n t o t h e s e q u e s t i o n s , what i s t h e r e l a t i v e e f f e c t -i v e n e s s o f f a m i l y g r o u p t h e r a p y w i t h r e g a r d t o c r i s i s -i n t e r v e n t i o n , l o n g term t r e a t m e n t g o a l s , s y m p t o m a t i c r e l i e f , o r b a s i c b e h a v i o u r p a t t e r n c h a n g e s ? R e l a t e d t o t h i s , i s I n f o r m a t i o n f o r t h e p r a c t i t i o n e r w i t h r e g a r d t o t h e d e t e r m i n a t i o n o f the o p t i m a l p o i n t o f c l o s u r e i n t r e a t m e n t , and t h e d e s i r a b i l i t y f o r f o l l o w - u p . 1 T h e r e i s a l s o a need t o i n q u i r e i n t o c o n t r o v e r s i a l I s s u e s r e g a r d i n g t e c h n i q u e s o f t r e a t m e n t . Of t h e v a r i o u s " s c h o o l s o f f a m i l y g r o u p t h e r a p y , " w h i c h t e c h n i q u e s o r c o m b i n a t i o n s o f t e c h n i q u e s p r o v e more s u c c e s s f u l f o r s p e c i f i c p r o b l e m s ? ^ The above q u e s t i o n s a r e a l l f o c u s e d on t h e n a t u r e o f - LIn d i s c u s s i o n w i t h Mr. S. Zimmerman, Mr. A. T e s s a r o , and D r . D. Davis,•members o f a f a m i l y g r o u p t h e r a p y t r e a t s ment team a t t h e E u r n a b y M e n t a l H e a l t h C e n t r e s i t was r e v e a l e d t h a t t h e r e i s some q u e s t i o n as t o what c o n s t i t u t e s c r i t e r i a f o r t h e o p t i m a l t i m e o f c l o s u r e . One member o f t h i s team f a v o u r s u s i n g t h i s t r e a t m e n t method f o r c r i s i s i n t e r v e n t i o n , and h o l d i n g s u b s e q u e n t f o l l o w - u p s e s s i o n s a t t h e c l i e n t ' s own i n i t i a t i v e . O t h e r s s t r i v e t o h e l p t h e f a m i l y a c h i e v e a c e r t a i n l e v e l o f a w a r e n e s s o f f a m i l y p r o c e s s e s . 2 I n d i s c u s s i o n w i t h above m e n t i o n e d t r e a t m e n t team i t was d e t e r m i n e d t h a t e a c h member l e a n e d t o w a r d a d i f f e r e n t s c h o o l o f p r a c t i s e . One member f o l l o w e d t h e " B e l l s c h o o l " a l m o s t e x c l u s i v e l y , w h i l e . t h e o t h e r s p r a c t i s e d d i f f e r e n t v a r i a t i o n s o f o r i e n t a t i o n s t e n d i n g t o r e l y a l i t t l e more h e a v i l y on t h e " S a t i r method" o f C o n j o i n t F a m i l y T h e r a p y . -3-the t r e a t m e n t . There a r e f u r t h e r i m p o r t a n t f a c t o r s t o be l e a r n e d about a t t r i b u t e s of the f a m i l y members wh i c h a re r e l e v a n t f o r t r e a t m e n t success. Some o f thes e a t t r i b u t e s i n c l u d e c a t e g o r y of d i a g n o s e d p a t h o l o g y , f a m i l y s t r u c t u r e , s o c i o - c u l t u r a l c l a s s i f i c a t i o n , f a m i l y s i z e , and age range of f a m i l y members.^ I t i s g e n e r a l l y c o n s i d e r e d a tendency t h a t lower c l a s s f a m i l i e s do not communicate v e r b a l l y as f r e e l y as h i g h e r c l a s s e s and t h a t they a r e more a u t h o r -i t a r i a n . Would t h i s i m p l y t h a t they would be i n g r e a t e r need o f t h i s t ype of t r e a t m e n t which s t r e s s e s f r e e r f l o w o f communications on a r e l a t i v e l y d e m o c r a t i c b a s i s , o r does I t mean t h a t t h e s e f a m i l i e s would n o t respond as w e l l t o t h i s form of t r e a t m e n t ? There have been some I m p r e s s i o n s by p r a c t i t i o n e r s t h a t m u l t i - p r o b l e m f a m i l i e s , f a m i l i e s w i t h an o l d e r d e l i n q u e n t , f a m i l i e s w i t h s c h i z o p h r e n i c members, and f a m i l i e s w i t h a f o s t e r c h i l d may not respond as w e l l t o t r e a t m e n t as do f a m i l i e s whose I d e n t i f i e d problem i s o f a d i f f e r e n t n a t u r e . 2 S i m i l a r l y , as i n o t h e r forms of t r e a t -ment t h e r e i s the q u e s t i o n o f the c h a r a c t e r i s t i c s of the t h e r a p i s t ' s p e r s o n a l i t y which e f f e c t the t r e a t m e n t p r o c e s s . Dr. J . E. B e l l , w h i l e a d d r e s s i n g a symposium a t the BMHC i n 1964, s t a t e d t h a t the low e r age l i m i t f o r c h i l d r e n t a k i n g p a r t i n f a m i l y group . t h e r a p y e f f e c t i v e l y was g e n e r a l l y around t e n y e a r s of age. I n a d d i t i o n . Dr. B e l l i m p l i e d t h a t t h i s form of t r e a t m e n t may be e f f e c t i v e i n a wide range o f p a t h o l o g y . 2 I n d i s c u s s i n g t h i s m a t t e r w i t h the f a m i l y group t h e r a p y team a t the BMHC i t was found t h a t i m p r e s s i o n s d i f f e r e d as t o w h i c h . f a m i l y t y p e s were more d i f f i c u l t t o t r e a t . One member f e l t he had b e t t e r s u c c e s s t h a n o t h e r p r a c t i t i o n e r s w i t h one p a r e n t f a m i l i e s , w h i l e a n o t h e r f e l t he c o u l d d e a l more e f f e c t i v e l y w i t h f a m i l i e s w i t h an o l d e r d e l i n q u e n t . However, a l l members f e l t t h a t m u l t i -problem f a m i l i e s and f a m i l i e s w i t h s c h i z o p h r e n i c members were most d i f f i c u l t t o t r e a t . What are the e f f e c t s of the t h e r a p i s t s age, appearance, sex, and/or behavioural mannerisms, on the dynamics of i n t e r a c t i o n i n therapy?! Extended research i n t h i s f i e l d would h o p e f u l l y a i d the t h e r a p i s t i n r e f i n i n g h i s techniques. How best can the i n t e r v i e w s t r u c t u r e b e n e f i t the treatment process? This would include such questions as home versus o f f i c e i n t e r v i e w s , 2 the use of c o - t h e r a p i s t s , 3 and v a r i o u s other i n t e r v i e w a i d s . An example of the l a t t e r would be the use of tape-recordings. I t has been suggested by some p r a c t i -t i o n e r s that a l l o w i n g f a m i l i e s to l i s t e n to play-backs of t h e i r i n t e r v i e w s on tape provides them w i t h the opportunity to recognize c e r t a i n communication patterns they would not recognize while the immediacy of t h e i r i n t e r a c t i o n i s ego-s y n t o n i c . The scope f o r research on techniques i s i n f i n i t e . Such p r a c t i c a l questions a r i s e as; degree of the use of i n t e r a c t i o n between f a m i l y members, the degree of t h e r a p i s t p a r t i c i p a t i o n , the use of c o n f r o n t a t i o n , and so on. F i n a l l y , research f i n d i n g s are not l i m i t e d to In d i s c u s s i o n w i t h the f a m i l y group therapy team i t was speculated that the t h e r a p i s t must be s u f f i c i e n t l y aggressive but not h o s t i l e , see Frances L. Beatman, Sanford N. Sherman, and Arthur L. Leader, "Current Issues i n Family Treatment," S o c i a l Casework, V o l . 4 7 9 No. 2i February, 1 9 6 6 , p. 79. p ^Home v i s i t s are thought by the treatment be u s e f u l w i t h r e s i s t a n t p a t i e n t s , but they have the d i s -advantage of i n t e r r u p t i o n s by phone c a l l s , s m a ll c h i l d r e n ^ and so on. In general i t was f e l t the o f f i c e i n t e r v i e w was s u p e r i o r because the p r a c t i t i o n e r ' s r o l e of a u t h o r i t y i n that s e t t i n g a f f o r d s him more c o n t r o l of the i n t e r v i e w . 3The treatment team f i n d s that c o - t h e r a p i s t s help w i t h the more d i f f i c u l t f a m i l i e s , but as a r u l e they p r e f e r r e d i n t e r v i e w i n g alone. p r a c t i c a l a p p l i c a t i o n s . The advancement o f t h e o r y w i t h r e g a r d t o e t i o l o g y o f p a t h o l o g y o f t e n b e n e f i t s f r o m 'post p o s t e r i o r i ' d e d u c t i o n s d e r i v e d f r o m o b s e r v a t i o n s o f i n t e r -a c t i o n and change a g e n t s i n b e h a v i o u r . F o r example, i n t h e e t i o l o g y o f s c h i z o p h r e n i a t h e r e h as b e e n t h e t h e o r e t i c a l a s s u m p t i o n t h a t c e r t a i n f o r m s o f c o m m u n i c a t i o n p a t t e r n s In. t h e f a m i l y ( " d o u b l e - b i n d " messages, and so on) b r i n g a b o u t s c h i z o p h r e n i c r e s p o n s e s . I t w o u l d l o g i c a l l y f o l l o w t h e n t h a t methods of c o r r e c t i n g t h e s e f a u l t y c o m m u n i c a t i o n p a t t e r n s c o u l d a l l e v i a t e o r p r e v e n t t h e c o n d i t i o n o f s c h i z o p h r e n i a . . F a i l u r e t o do so w o u l d c a s t some d o u b t on t h e o r y o f c a u s a t i o n , b r i n g i n g a b o u t m o d i f i c a t i o n s i n t h e o r y . R e s e a r c h i n f a m i l y g r o u p t h e r a p y h as wide i m p l i c a t i o n s f o r s o c i a l w e l f a r e p o l i c y . Community p o l i c y makers may u s e t h e p r e l i m i n a r y r e s e a r c h f i n d i n g s a s i n d i c a t o r s f o r t h e d i r e c t i o n o f more c o m p r e h e n s i v e and e x t e n s i v e s t u d i e s . One such a g e n c y t o u n d e r t a k e r e s e a r c h I s t h e Community C h e s t and C o u n c i l 3 b u t . i n a d d i t i o n , government sponsored a g e n c i e s m i g h t employ more f u l l - t i m e r e s e a r c h e r s t o i n i t i a t e a nd d i r e c t s p e c i f i c p r o j e c t s . 1 At p r e s e n t , r e s e a r c h i s a s e c o n d a r y c o n s i d e r a t i o n b e i n g l e f t l o c a l l y m a i n l y t o s t u d e n t s c o m p l e t i n g t h e i r s o c i a l work t r a i n i n g . T h r o u g h g o v e r n m e n t a l s p o n s o r i n g , l a r g e r , more l o n g i t u d i n a l s t u d i e s c a n be o r g a n i z e d and i n i t i a t e d i n t h i s a r e a . S h o u l d t h i s t r e a t m e n t t e c h n i q u e p r o v e e f f e c t i v e , t h e n t h e q u e s t i o n w o u l d a r i s e a s t o w h e t h e r t h e r e i s a ne e d t o -'-Mr. D. R i c k e t t s , D i r e c t o r o f S o c i a l S e r v i c e a t BMHC;, was most h e l p f u l f o r h i s c o - o p e r a t i o n in. d i s c u s s i n g p o l i c y and a d m i n i s t r a t i v e p r o c e d u r e s . - 6 -determine the q u a l i t y of workers t r a i n e d i n f a m i l y group treatment to be employed by s o c i a l welfare agencies. Thus, o p p o r t u n i t i e s may need to be provided through agency spon-sored i n s t i t u t e s , and/or i n - s e r v i c e t r a i n i n g . (To the researcher's knowledge t h i s has already been i n i t i a t e d by the P r o v i n c i a l P r o b a t i o n S e r v i c e , Burnaby Mental Health C l i n i c , and Vancouver Family S e r v i c e Agency). In r e l a t i o n to the nature and extent of r e q u i r e d t r a i n i n g , p o l i c y may have to be r e v i s e d to incorporate the appropriate programs i n Schools of S o c i a l Work c u r r i c u l a . , Is the r e s p o n s i b i l i t y then to r e s t w i t h the agencies, w i t h the p r o v i n c i a l govern-ment, or w i t h the School of S o c i a l Work? This leads i n t o another question having to do with the s t a f f i n g of agencies. Because of the s p e c i a l i z e d nature of these s k i l l s , i t may be imperative to upgrade i n c e n t i v e . One such proposal has been made to the p r o v i n c i a l government to provide a new category of s e n i o r p r a c t i t i o n e r . For example, smaller agencies w i l l not have supervisors q u a l i f i e d to oversee f a m i l y t h e r a p i s t s ' work. In a d d i t i o n , the l a t t e r ' s g r e a t e r degree of s p e c i a l i z a t e d t r a i n i n g may warrant higher i n c e n t i v e s . Agency p o l i c y makers could use i n f o r m a t i o n gained through f u r t h e r i n v e s t i g a t i o n of t h i s form of treatment. F i r s t , knowledge of the e f f e c t i v e n e s s of fa m i l y group therapy would help i n decision-making w i t h regard to the intake process of an agency. T h u s , d i s p o s i t i o n of incoming cases could be made more e f f i c i e n t , u t i l i z i n g the maximum e f f e c t -iveness of the p r a c t i t i o n e r ' s use of time. There have been some impressions by p r a c t i t i o n e r s that i n c e r t a i n cases, -7-t h e s e t e c h n i q u e s r e q u i r e a s h o r t e r s t a y i n t r e a t m e n t . S e c o n d l y , a g e n c y s t a f f i n g w i l l r e q u i r e knowledge o f t r a i n -i n g r e q u i r e m e n t s i n r e c r u i t m e n t o f p e r s o n n e l . The a g e n c y w i l l n e e d t o be aware o f t h e t r a i n i n g s p e c i f i c a t i o n s most e f f e c t i v e f o r t h e i r p a r t i c u l a r p r o g r a m . C e r t a i n s c h o o l s o f f a m i l y g r o u p t h e r a p y may seem more d e s i r a b l e t h a n o t h e r s f o r a p a r t i c u l a r a g e n c y o r i e n t a t i o n , f o r c e r t a i n c l i e n t e l e , and f o r p a r t i c u l a r p r o b l e m s d e a l t w i t h . I f f i r m l y e s t a b l i s h e d p r i n c i p l e s c a n be d e r i v e d f r o m o n g o i n g s t u d i e s , t h e community a t l a r g e w o u l d b e n e f i t f r o m e d u c a t i o n a l p r o g r a m s d e r i v e d f r o m t h e knowledge g a i n e d . D o c t o r s , e d u c a t i o n c o u n s e l l o r s , c l e r g y , l a w y e r s , s o c i a l a g e n c i e s a n d a h o s t o f o t h e r r e f e r r a l a g e n t s c o u l d be made aware o f t h e c r i t i c a l f a c t o r s i n f a m i l y f u n c t i o n i n g w h i c h w o u l d r e q u i r e a t t e n t i o n a t a n a g e n c y o f f e r i n g f a m i l y g r o u p t h e r a p y as a t r e a t m e n t p r o g r a m , S i m i l a r l y , w i d e s p r e a d knowledge o f t h i s f o r m o f t r e a t m e n t c o u l d be communicated t o p o t e n t i a l c l i e n t g r o u p s i n t h e community. T h e r e a r e some i n d i c a t i o n s t h a t a t t h e o n s e t o f t r e a t m e n t i n f a m i l y g r o u p t h e r a p y t h e f a m i l y i s a l i e n a t e d by t h e i r u n f a m i l i a r i t y w i t h t h i s a p p r o a c h . P o s s i b l y t h i s n e g a t i v e " i n t e r v i e w e e s e t " may e x p l a i n why d r o p - o u t s a r e p a r t i c u l a r l y h i g h d u r i n g t h e i n i t i a l s t a g e s o f t r e a t m e n t . 1 P a r t i c u l a r l y s o u n d know-l e d g e w o u l d be n e e d e d b e f o r e an e d u c a t i o n a l p r o g r a m o f t h i s •^In d i s c u s s i o n w i t h Mr. D. R i c k e t t s , S o c i a l S e r v i c e D i r e c t o r o f t h e BMHC, i t was s p e c u l a t e d t h a t t h e a l l e g e d "ego a s s a u l t i v e " e l e m e n t s o f f a m i l y g r o u p t h e r a p y may be i n f a c t due t o f a m i l i a r i t y t h e c l i e n t has w i t h t r a d i t i o n a l t e c h n i q u e s a s s o c i a t e d w i t h i n d i v i d u a l p s y c h o t h e r a p y . T h e s e i m p r e s s i o n s c a n be g a i n e d t h r o u g h m o v i e s , t e l e v i s i o n , , l i t e r a t u r e , h e r e s a y , a n d so on. -8-t y p e i s i n a u g u r a t e d , i n o r d e r t o a v o i d m i s c o n c e p t i o n s b u i l t a r o u n d a " m y s t i q u e " a s s o c i a t e d w i t h h a l f - t r u t h s a b o u t f a m i l y g r o u p t h e r a p y as seems t o have b e e n t h e c a s e w i t h p s y c h o -a n a l y s i s . Hence, i f a g e n c i e s s p e c i a l i z i n g i n f a m i l y g r o u p t h e r a p y were s e t up w i t h i n t h e community o r i f t r e a t m e n t u n i t s w i t h i n o t h e r community s e r v i c e s were t o o f f e r t h i s t r e a t m e n t , f a m i l i e s who r e c o g n i z e t h a t t h e y have a p r o b l e m t r e a t a b l e by t h e s e t e c h n i q u e s c o u l d a p p l y f o r t r e a t m e n t d i r e c t l y , a s p e o p l e now do f o r m a r i t a l c o u n s e l l i n g . F i n a l l y , we c a n s p e c u l a t e t h a t r e s e a r c h w i t h i n t h i s a r e a c o u l d b e n e f i t o t h e r d i s c i p l i n e s u s i n g t h e s e t e c h n i q u e s . Q u e s t i o n s r a i s e d by S o c i a l Work r e s e a r c h i n f a m i l y i n t e r -a c t i o n c a n be o f some u s e t o c o m m u n i c a t i o n s t h e o r i s t s s t u d y i n g c o m m u n i c a t i o n s p a t t e r n s ; i t c o u l d be u s e d by s o c i a l p s y c h o l o g i s t s and s o c i o l o g i s t s , s t u d y i n g s m a l l g r o u p i n t e r -a c t i o n s . ; i t may be u s e f u l t o p s y c h i a t r i s t s c o n c e r n e d w i t h p a t h o l o g i c a l p r o c e s s ; e d u c a t o r s i n t e r e s t e d i n t h e e f f e c t s o f f a m i l y r e l a t i o n s h i p s on l e a r n i n g b e h a v i o u r ; p s y c h o l o g i s t s i n f u r t h e r i n g p e r s o n a l i t y t h e o r y , a n d so f o r t h . The above i n d i c a t e s t h e many . . r a m i f i c a t i o n s o f t h i s b a s i c p r o b l e m . The n e x t t a s k i s t o f o c u s t h i s r e s e a r c h p r o j e c t on t h o s e a s p e c t s t o w h i c h i t i s a d d r e s s e d . The P r o b l e m f o r R e s e a r c h ^ As can. be s e e n from t h e f o r e g o i n g d i s c u s s i o n t h e r e a r e s e v e r a l p o s s i b l e r e s e a r c h p r o b l e m s g r o w i n g o u t o f t h e use o f f a m i l y g r o u p t h e r a p y a s a t r e a t m e n t t e c h n i q u e i n s o c i a l work p r a c t i s e . We f e l t t h a t a m a j o r p r o b l e m f o r r e s e a r c h a t t h i s point was the evaluation of the extent to which family group therapy does or does not result in improved (bring about a change) family functioning. In an area where l i t t l e or no research exists, the question of whether or not family group therapy is effective in producing change seems of v i t a l importance (as a f i r s t step in research). The most conclusive way to answer this question would be to conduct a full-scale experimentally designed study, using a c o n t r o l group, and rating the groups as t o "family functioning" b e f o r e , during, and after treatment. We f e l t this was not possible, for at least.two reasons: (1) the time and f a c i l i t i e s a t our disposal do not permit us to conduct a study of this kind: (2) a f i e l d which as y e t has had limited development is not prepared for elaborate experi-mental designs -to t e s t abstract hypotheses.- F o r t h e s e reasons we have chosen to do a follow-up s t u d y of an explor-atory (fcrmulative) nature, in which we have e x p l o r e d the client's own perceptions of change, or no change i n f a m i l y functioning following family group therapy, and the e x t e n t to which changes., i f any, are associated i n the c l i e n t ' s mind w i t h their having received family group t h e r a p y . These perceptions we have compared with: ( 1 ) the family group therapists' perceptions and rating o f change a t the time of case closing; and (2) our own impressions o f f a m i l y f u n c t i o n -ing at the time o f our follow-up interviews. We feel there are some advantages to this k i n d of approach, and t h a t the study w i l l have something t o contribute •'"Polansky, N. A. (ed.) , Social Work Research, University of Chicago Press, Chicago; 1960s p. 51» - 1 0 -t o ' t h e u n d e r s t a n d i n g of the s o c i a l work problem. On a br o a d b a s i s , we f e e l t h a t o ur study p o i n t s up the whole q u e s t i o n o f the f e a s i b i l i t y o f a f o l l o w - u p study i n the a r e a of f a m i l y group t h e r a p y . The d i s c u s s i o n of p r a c t i c a l problems w i t h which we have had t o d e a l , such a s : (1) the attidu.es of c l i e n t s towards p a r t i c i p a t i n g i n a f o l l o w - u p s t u d y ; (2) the r e l i a b i l i t y o f the i n f o r m a t i o n o b t a i n e d ; (3) the amount o f p l a n n i n g and p r e p a r a t i o n needed t o conduct the s t u d y ; and (4) the problem of who t o I n c l u d e i n the s t u d y , ( e . g . whether t o i n c l u d e those who have had o n l y one i n t e r v i e w ) , s h o u l d be h e l p f u l t o per s o n s who a r e c o n s i d e r i n g s i m i l a r s t u d i e s . Knowledge of p o t e n t i a l d i f f i c u l t i e s i n f o l l o w - u p s t u d i e s o f f a m i l y group t h e r a p y s h o u l d a l s o prove u s e f u l t o p r a c t i t i o n e r s i n d e c i d i n g whether o r n ot f a m i l i e s who may be c o n t a c t e d f o r f o l l o w - u p purposes a t a f u t u r e date s h o u l d be p r e p a r e d f o r t h i s p o s s i b i l i t y a t the time o f t e r m i n a t i o n . The s t u d y p r o v i d e s some p r e l i m i n a r y i n f o r m a t i o n cn t h r e e of the key problems r e l a t i n g t o f a m i l y group t h e r a p y w h i c h s h o u l d be u s e f u l t o p r a c t i t i o n e r s , a g e n c i e s s and f u t u r e r e s e a r c h e r s . F i r s t l y , i t p r o v i d e s p r e l i m i n a r y i n f o r m a t i o n upon what a s p e c t s of f a m i l y l i f e f a m i l y group t h e r a p y has an e f f e c t . S e c o n d l y , w i t h r e g a r d t o the problem of whose c r i t e r i a s h o u l d be g i v e n . t h e most w e i g h t i n a s s e s s -i n g outcome: (1) those of the t h e r a p i s t ; (2) the r e c i p i e n t s o f the s e r v i c e ; o r (3) o t h e r s i n . the community, t h i s s tudy w i l l p r o v i d e i n f o r m a t i o n on how the f i r s t two a g r e e . The t h i r d key problem on wh i c h i t p r o v i d e s some p r e l i m i n a r y 11 Information is that of the "drop out" rate. We have con-cerned ourselves with the question as to.whether change occurs less often in the families who "drop out" of treat-ment as planned. Along these same lines, we have also concerned ourselves with exploring whether a relationship appears to exist between the- number of therapy sessions participated in and the degree of changes which take place. Introduction to theoretical concepts Section: As family group therapy is a comparatively new f i e l d of study there are as yet not many authors on the subject. For our development of the theoretical framework on family group therapy i t was decided to confine our discussion to those authors who had the greatest influence on family group therapy as i t was practised at the Mental Health Centre. These authors have a l l participated in developing both the theoretical and treatment aspects of family group therapy and have.also worked with a significant number of families. The many other recent authors In the f i e l d of family group therapy have not really influenced therapy at the Mental Health Centre to the degree of Satir, Bell, Rabkin, and Hayley have and w i l l therefore only be included in an annotated bibliography. Virginia S a t i r 1 has become recognized in the last five years as one of the foremost authorities on family group therapy. She developed, used, and now teaches her own particular form of family group therapy. Although the sample ^Satlr, Virginia, Conjoint Family Therany„ Science and Behaviour Books. Inc., Palo Alto, California; 1 9 6 4 . - 1 2 -that we are studying in this project was treated before the publication of Satir's book, she had written several papers and articles which had an influence on family group therapists: at the Mental Health Centre. Personal v i s i t s of the therapists to Satir and by her to the c l i n i c have strongly re-inforced her influence. Conjoint Family Therapy: A guide to theory and techniques by Virginia Satir is a point by point compilation of her conceptual approach to family group therapy as well as the actual treatment. The purpose of the "book was to present a strong argument about the importance of family group therapy. The book is an impressionistic writing based on the author's personal experiences. She suggests that a l l types of mental illness may be treated by her method. Satir, to substantiate her claim.puts forth a rationale for family group /therapy. Firstly, she feels that the unhappiness or pain f e l t by one family member is rejected and reacted against by a l l family, memberso There is a tendency in this reaction to perpetuate the identified patient's symptoms. The family attempts to achieve some balance and for this concept Satir relies on Don Jackson's term "family homeostasis". This balance is d i f f i c u l t to maintain and requires effort a l l round. A particular family homeostasis is in the most part character-ized by the quality of the marital relationship. The identified patient is the family.member who is reacting most obviously to the dysfunctioning marital'relationship. As the patient's symptoms do play an important role in - 1 3 -preserving even the pathological family balance It is necessary to treat the whole family as a unit so that along with improvement in symptoms of the Identified patient a new family balance can be achieved. Satlr feels that the basic problem lies behind the marital pair. Each enters the marriage hoping to gain something from the other but feeling that they have nothing to give. When the reality of twenty-four hour marriage occurs both partners feel they have nothing to give, there-fore get nothing either. As they are getting nothing, disagreement results and communication' becomes obscured. Children are unable to react without symptoms to a very confusing situation. Virginia Satir bases much of her therapy on regaining this communication. She devotes an entire two. chapters in. her book to. communication theory. Communication is the process of giving and getting information but in the process of transmission this information can become very distorted. The goal through-out therapy is to realign the communication so that family members are receiving, sending, and comprehending the total content of any message. Satir, very painstakingly,dissects the verbal injections of each person and c l a r i f i e s each, word and xnjection as i t is said u n t i l gradually family members become more aware of the areas, of feeling and confusion. The actual treatment in family group therapy does not actually begin in a l l cases with a l l family members present. Usually an assessment of the adults is made f i r s t . In this, Virginia Satir differs from J . E. Bell who sees the -14-farally only in a complete group. If the family Is assessed and found suitable for family group therapy, then the f i r s t one or two interviews usually consists of history taking. The children, through this process, begin to see their parents as people who existed with their own personalities before they were born. After this process she usually begins her study of the families'communication patterns. The re-establishment of meaningful communication plus an increase in feelings of self-esteem are the goals of Satir"s work. Through the use of clear communication by family members with high self-esteem, most external and internal crises can be dealt with. John Elderkin Bell is the most prominent of the early family group therapists in the United States. He was discouraged with the lack of success of Individual treat-ment methods used with adolescents. Dr. Bell's interest in family group therapy stems;from Dr. Bowlby's work with adolescents and their families at London's Tavistock Clinic. Prom this fleeting contact with Dr. Bowlby he developed family group therapy as he practices i t today. Bell's methods, developed earlier than S a t i r 1 s , are different in many respects. However, the basic goal is the same and that, is to treat the family not as an assembly of Individ-uals but as a recognized biological and social unit. There are not individual problems (as Satir allows) but only family problems. In "conferences", as Bell calls treatment sessions, the therapist relates to the family and resists any effort on the part of individuals to relate to him as an individual. -15-Th ough B e l l ' s b a s i c g o a l w i t h a f a m i l y i s t o im p r o v e f u n c t i o n i n g he comes i n t o t r e a t m e n t w i t h e v e r y f a m i l y r e a d y t o h e l p them d e v e l o p t h e i r own g o a l s f r o m t h e i r p a r t i c u l a r c u l t u r a l m a t r i x . Ke f e e l s t h a t " t h e c l i m a t e o f f e r i n g f r e e d o m f o r t h e d e v e l o p m e n t • o f t h e most s a t i s f a c t o r y complex o f f a m i l y r o l e s seems t o r e q u i r e c o n s c i o u s n e s s by t h e f a m i l y o f t h e i m p a c t t h a t e a c h member, has on e a c h o t h e r member." 1 T h i s i s a c t u a l l y much t h e same c o n c e p t a s a d o p t e d by S a t i r i n h e r a t t e m p t t o have, f a m i l y members c l a r i f y c o m p l e t e l y what e a c h i n d i v i d u a l i n t e n d s i n e v e r y i n t e r a c t i o n w i t h e v e r y o t h e r member. D e l i n e a t i o n o f f a m i l y r o l e s and e x p e c t a -t i o n s t h e r e i n s h o u l d be a r e s u l t o f t h e c l a r i f i c a t i o n o f f a m i l y members i m p a c t on e a c h o t h e r . I t i s hoped t h a t s t e r e o t y p e d g e n e r a l i z a t i o n s w i l l be abandoned and r e p l a c e d by more a c c u r a t e r e c o g n i t i o n o f v a r i o u s f a m i l y members' r o l e s . A n o t h e r g o a l i n B e l l ' s g e n e r a l t h e o r e t i c a l o u t l i n e o f f a m i l y g r o u p t h e r a p y i s t o e n a b l e t h e f a m i l y t o r e c o g n i z e t h e i r e s s e n t i a l u n i t y a n d m u t u a l " i n t e r d e p e n d e n c e on e a c h o t h e r and on t h e f a m i l y as a whole . . . . W h i l e t h i s may be t h o u g h t o f as a c o n s e q u e n c e o f t h e t h e r a p y , s i n c e f o r the most p a r t i t i s t o be f o u n d i n t h e f i n a l s t a g e s , i t i s a l s o t r u e t h a t i t i s a f a c t o r i n b r i n g i n g a b o u t t h e t h e r a p e u t i c p r o g r e s s . " 2 By e n c o u r a g i n g t h e f a m i l y t o v e r b a l i z e t h e p o s i t i v e s a s w e l l a s t h e d i f f e r e n c e s B e l l hopes t o d e v e l o p t h e s e f e e l i n g s o f t h e f a m i l y u n i t . 1 B e l l , J . E . F a m i l y Group T h e r a p y . P u b l i c H e a l t h Monograph, No. 64, U. S. P r i n t i n g O f f i c e , I 9 6 I , p . 5. 2 I b i d . , p . 6. -16-B e l l ' s a c t u a l t h e r a p y s e s s i o n s d i f f e r f r o m Satir's» T h e r e i s n o t n e a r l y so g r e a t a n e m p h a s i s on v e r b a l i z a t i o n and much e m p h a s i s i s on n o n - v e r b a l c o m m u n i c a t i o n . He i s n o t so c o n c e r n e d w i t h d i s s e c t i n g c o m m u n i c a t i o n b u t more i n p r o v i d i n g I n s i g h t i n t o t h e a c t u a l b e h a v i o u r p r o m p t i n g t h e c o m m u n i c a t i o n . B e l l b e g i n s t h e r a p y n o t w i t h a h i s t o r y g i v e n by t h e p a r e n t s b u t a f t e r a b r i e f i n t r o d u c t i o n he a s k s t h e c h i l d r e n what changes t h e y w o u l d l i k e t o see i n t h e f a m i l y . No m a t t e r what t h e s e changes a r e t h e y a r e d i s c u s s e d i n v i e w o f p o s s i b l e i m p l e m e n t a t i o n . , B e l l , u n l i k e S a t i r , n e v e r s e e s any f a m i l y members i n d i v i d u a l l y as he c o n s i d e r s I t e s s e n t i a l t h a t t h e f a m i l y a l w a y s be r e a c t e d t o a s a g r o u p . B o t h B e l l and S a t i r have b a s i c a l l y t h e same g o a l s and the. r e s u l t s . o f . t r e a t m e n t a r e t h e same b u t t h e t e c h n i q u e s u s e d d i f f e r . A c o m b i n a t i o n o f b o t h o f t h e s e methods w i t h more emphasis, o n . B e l l was u s e d a t t h e M e n t a l H e a l t h C e n t r e d u r i n g t h e t i m e t h e sample f a m i l i e s were t r e a t e d . P r e v i o u s R e s e a r c h : . ' • I n s u r v e y i n g t h e l i t e r a t u r e s e a r c h i n g f o r p r e v i o u s r e s e a r c h r e l a t i v e t o f a m i l y g r o u p t h e r a p y , i t i s p a r t i c u l a r l y n o t i c e a b l e t h a t t h e r e i s . a l a c k o f r e s e a r c h b e i n g done i n t h i s a r e a . The w r i t i n g s and a r t i c l e s a r e d e s c r i p t i v e i n t e r m s o f m e t h o d o l o g y and r a t i o n a l e f o r t h e . i m p l e m e n t a t i o n o f f a m i l y g r o u p t h e r a p y , however, l i t t l e c o u l d be f o u n d c e n t e r i n g on a f o l l o w - u p c a s e s t u d y o f t h e b e n e f i t s , c h a n g e s , i m p r o v e m e n t s , e t c . , a f t e r h a v i n g b e e n t r e a t e d i n f a m i l y g r o u p t h e r a p y s e s s i o n s . The t r e a t m e n t o f an e n t i r e f a m i l y , i n t e r v i e w e d t o g e t h e r as a g r o u p i s a new p r o c e d u r e i n - 1 7 -psychiatry, although t h i s has been more common i n the prac-t i c e of s o c i a l work. There have been questions as to when family group therapy appeared on the scene. It i s generally held by most p r a c t i t i o n e r s i n s o c i a l work and psychiatry, that i t was about a decade ago. However, Haley points out that just when family therapy originated i s d i f f i c u l t to estimate because the movement has l a r g e l y been a secret one. 1 Only u n t i l most recently therapists who treat whole families have not published on t h e i r methods, and t h e i r studies are r e l a t i v e l y rare.\ The secrecy about family therapy has two sources, according to Haley, which are: 1 . "Those using t h i s method have been too uncertain about t h e i r techniques and results to commit themselves to p r i n t , and, 2 . there has been apparently a fear of charges of heresy because the: influence of family members has been considered i r r e v e l a n t to the nature and cure of psychopathology i n a p a t i e n t . " 2 I t i s only most recently that the family group therapy movement has come to the surface and there are three general arguments offered for treating the family as a whole rather than the i n d i v i d u a l with symptoms, as postulated by Haley, which are: a). ". . . often Individual therapy has f a i l e d with a type of patient, or a p a r t i c u l a r patient, and i t i s argued that his family environment i s preventing change and should be treated, -'-Haley, Jay. "Wither Family Therapy," Family  Process. V o l . 1 , No. 1 , March, 1 9 6 2 , p. 6 9 . 2 I b i d . , -18-b) . when i n d i v i d u a l t r e a t m e n t i s s l o w , d i f f i c u l t , and s u b j e c t t o r e l a p s e s , i t I s s i n g u l a r l y a r g u e d t h a t t h e e n v i r o n m e n t o f t h e p a t i e n t i s i n h i b i t i n g c h a n g e, a n d , c) . t h e a p p e a r a n c e o f d i s t r e s s and symptoms i n o t h e r f a m i l y members when t h e p a t i e n t i m p r o v e s r a i s e s q u e s t i o n s a b o u t t h e r e s p o n s i b i l i t y o f a t h e r a p i s t t o o t h e r f a m i l y members."1 H a l e y seems t o have t a k e n t h e l e a d i n d e v e l o p i n g r e s e a r c h r e l a t i v e t o f a m i l y g r o u p t h e r a p y . One s u c h r e s e a r c h r e p o r t d e a l s w i t h an I n t e r a c t i o n a l s t u d y whereby t h e f a m i l i e s a r e o b s e r v e d i n c o n j o i n t i n t e r v i e w s where t h e y a r e a s k e d s t a n d a r d q u e s t i o n s , i n f a m i l y t h e r a p y s e s s i o n s , o r t h e y a r e e x p o s e d j o i n t l y t o a t a s k , s u c h as p l a y i n g a game t o g e t h e r , o r g i v i n g t h e i r i m p r e s s i o n s o f TAT o r R o r s c h a c h c a r d s . Two s o r t s o f measurements a r e a t t e m p t e d i n t h e s e s t u d i e s : ( 1 ) t h e c o u n t i n g o f t h e r e s p o n s e s t o t h e t a s k by f r e q u e n c y o r t i m e ; and ( 2 ) t h e c a t e g o r i z a t i o n o f t h e v e r b a l i n t e r c h a n g e o f t h e f a m i l y c o n v e r s a t i o n , 2 i n o r d e r t o measure t h e s e q u e n t i a l f r e q u e n c y i n f a m i l y c o m m u n i c a t i o n p a t t e r n s . One o f H a l e y ' s h y p o t h e s e s i n t h i s s t u d y was t h a t , When a f a m i l y f a l l s i n t h e d i s t u r b e d r a n g e c n t h e s c a l e o f d e v i a t i o n f r o m random b e h a v i o u r and i s t r e a t e d s u c c e s s f u l l y by f a m i l y t h e r a p y , the f a m i l y w i l l move t o w a r d s a n o r m a l r a n g e . 3 I t i s t h e g o a l o f t h e f a m i l y t h e r a p y s e s s i o n s t o e n c o u r a g e more e q u a l p a r t i c i p a t i o n i n f a m i l y d i s c u s s i o n s by f a m i l y members. I n r e f e r e n c e t o t h e h y p o t h e s i s s t a t e d a b o v e . -'•Haley, l o c . c i t . 2 H a l e y , J a y . " R e s e a r c h on F a m i l y P a t t e r n s : An I n s t r u -ment Measurement," F a m i l y P r o c e s s . V o l . 3, No. 1, M a r c h s 1964, p. 43. I b i d . , p. 51. - 1 9 -H a l e y f e e l s t h a t " s u f f i c i e n t d a t a i s n o t y e t a v a i l a b l e t o t e s t t h i s h y p o t h e s i s . " 1 D e s c r i p t i o n s o f s i x f a m i l i e s were r e p o r t e d who were t e s t e d b e f o r e t r e a t m e n t and t h e n were g i v e n e x a c t l y t h e same t e s t w i t h t h e same i n t e r v i e w e r s i x months l a t e r . The f i r s t f o u r f a m i l i e s were t r e a t e d by t r a i n i n g t h e r a p i s t s , and t h e i r s u p e r v i s o r s r e p o r t e d i n d e p e n d e n t l y t h a t he f e l t none o f t h e s e f a m i l i e s h a d u n d e r g o n e any b a s i c c h ange. "The r e s u l t s h e r e s u p p o r t t h a t c o n c l u s i o n : a l l t h e f a m i l i e s moved t o w a r d t h e n o r m a l r a n g e o f t h e s c a l e , b u t o n l y s l i g h t l y . " 2 To d e t e r m i n e w h e t h e r f a m i l i e s change w i t h f a m i l y t h e r a p y , i t was n e c e s s a r y t o c o n s i d e r how n o r m a l f a m i l i e s change on t e s t and r e - t e s t w i t h o u t t h e i n t e r v e n t i o n o f a t h e r a p i s t . A t t h i s p o i n t s i x n o r m a l f a m i l i e s were g i v e n a t e s t and s u b s e q u e n t l y g i v e n t h e same t e s t s i x months l a t e r ( T A T ) . H a l e y f o u n d th a t , t h e n o r m a l f a m i l i e s change o n l y s l i g h t l y l e s s t h a n t h e g r o u p o f t r e a t e d f a m i l i e s ^ P e r h a p s H a l e y ' s d e m o n s t r a t i o n o f t h e g r e a t e r u s e o f m e c h a n i c a l r e c o r d i n g d e v i c e s t o t a k e t h e most s i m p l e measurements o f f a m i l y i n t e r a c t i o n w i l l l e a d t o f u r t h e r a d o p t i o n o f t h i s m e t h o d o l o g y . " I n i t s . own way, t h i s a d m i t t e d l y c r u d e measure o f f a m i l y p a t t e r n s i s no more p r i m i t i v e t h a n t h e k i n d s o f e v a l u a t i o n s b e i n g c a r r i e d o u t by o b s e r v e r s whose c a p a c i t y f o r a p p r e h e n d i n g t h e i n t r i c a t e t o t a l i t y o f i n t e r a c t i o n l e a v e s much t o be d e s i r e d . " ^ .•'•Haley, F a m i l y P r o c e s s , V o l . 3 3 No. 1, p . 57. 2 I b l d o 3 I b i d . ^ R a b k i n , L e s l i e I . "The P a t i e n t ' s F a m i l y : R e s e a r c h Methods," F a m i l y P r o c e s s , V o l . 4, No, 1, March, 1965, p. 121. -20-Rabkin points out several d i f f i c u l t i e s i n u t i l i z i n g the case history study method of research. The f i r s t d i f -f i c u l t y Is that these h i s t o r i e s are not gathered for research purposes but are generally part of the c l i n i c a l evaluation of the patient. "Thus, only c e r t a i n items tend to get tabulated, those considered by the s o c i a l worker to be relevant to the etiology of the patient's disorder. This means that c e r t a i n t h e o r e t i c a l notions intrude into what gets recorded."-*' Another d i f f i c u l t y with the case history study method i s that once the records are chosen f o r analysis, there arises problems of a control group. "There has been an unfortunate tendency to choose control groups, i f they have been used at a l l , more on the basis of t h e i r a v a i l a b i l i t y rather than t h e i r relevance to the study." 2 Guiding Questions f o r Study. We have embarked on an exploratory study of the e f f e c t s of family group therapy on a client-group from the Burnaby Mental Health Centre. Rather than posing an hypothesis, we have formulated s p e c i f i c questions which we have used to guide our exploration of t h i s subject. Since we set out to study the r e l a t i o n s h i p between change i n family functioning and family group therapy, our questions are b a s i c a l l y t r y -ing to get at change, f i n d relationships among various variables, and f i n a l l y endeavouring to make connection between the six areas of family functioning and improvement •'•Jiabkin, OP. c i t . , . p. :110. 2 I b i d . , p. I l l -21-i n family group therapy. 1. What changes i n family functioning are reported by family members as being d i r e c t l y related to something that happened i n family group therapy? Here we believe that certain c r i t e r i a must be met f o r change to take place. We have drawn from the material by V i r g i n i a S a t i r for this section. Some of the c r i t e r i a included would be improved understanding of what i s said by family members, considera-t i o n of fe e l i n g s , p a r t i c i p a t i o n of a l l family members i n discussions, etc. 2 . What changes i n the roles of family members are perceived by them to be related to family group therapy? We believe that an important area i n family functioning i s the matter of r o l e s . We need only turn to the work of the so c i o l o g i s t , Robin N. Williams, J r . , 1 to be aware of i t s importance. Thus we w i l l look at the family's role expectations, note perceptions, role performance, etc. It should be noted that the therapists themselves place a great deal of emphasis on changes i n this area and this Is one area of c r i t e r i a which they consider i n the successful termination of t h e i r cases. 3.. What changes i n the i n t r a - f a m l l i a l relationships within the family are perceived by them to be related to family group therapy? Here again, we have drawn both from the writings of V i r g i n i a S a t i r and the personal experience of the three therapists f o r the i n c l u s i o n of thi s question. We are interested In looking at family alignments and how Williams, Robert M. American Society. A l f r e d A. Knopf, New York; 1951, pp. 55-73. - 2 2 -t h e y were a f f e c t e d by f a m i l y g r o u p t h e r a p y . We a l s o i n c l u d e h e r e t h e q u e s t i o n o f s c a p e g o a t i n g , m a r i t a l e x p e c t a t i o n s and s a t i s f a c t i o n , e t c . I n f o r m a t i o n i n t h e s e a r e a s w i l l h e l p i n t h e a n s w e r i n g of t h i s q u e s t i o n . 4. What changes i n t h e f a m i l y ' s use o f a v a i l a b l e community r e s o u r c e s a r e p e r c e i v e d by them t o be r e l a t e d t o f a m i l y g r o u p t h e r a p y ? We have h y p o t h e s i z e d t h a t a f a m i l y w h i c h has b e e n e x t r e m e l y a c t i v e i n t h e community, u s i n g r e s o u r c e s , w i l l come b a c k i n t o h i s f a m i l y i f h e l p e d by f a m i l y g r o u p t h e r a p y . The o p p o s i t e m i g h t a l s o be e x p e c t e d , t h a t i s , t h e f a m i l y w h i c h has been i s o l a t e d and t o t a l l y d i v o r c e d f r o m p a r t i c i p a t i o n i n the community, w i l l go o u t and become more i n d e p e n d e n t and i n d i v i d u a l i s t i c . 5. What- changes i n t h e o c c u p a t i o n a l and e d u c a t i o n a l s i t u a t i o n o f t h e f a m i l y a r e p e r c e i v e d by them t o be r e l a t e d t o f a m i l y g r o u p t h e r a p y ? We b e l i e v e t h a t a f a m i l y h e l p e d by f a m i l y g r o u p t h e r a p y w i l l f i n d more s a t i s f a c t i o n on t h e j o b o r a t s c h o o l , and h i s p e r f o r m a n c e may e v e n Improve. Our r a t i o n a l e h e r e i s t h a t t h e i n d i v i d u a l i s f r e e d f r o m t h e b u r d e n o f w o r r y a t home and a p p r o a c h e s work w i t h a more r e l a x e d a t t i t u d e . The t h e r a p i s t s b e l i e v e t h a t f a t h e r may b e t t e r h i m s e l f o c c u p a t i o n a l l y and t h e c h i l d w i l l do b e t t e r a t s c h o o l . 6. What i s t h e r e l a t i o n s h i p , i f any, b etween any change i n f a m i l y f u n c t i o n i n g and t h e f a m i l y ' s o c c u p a t i o n l e v e l , 1 Here we a r e l o o k i n g a t t h e f a m i l i e s i n w h i c h some change has t a k e n p l a c e and xve b e l i e v e t h a t t h e y p r o b a b l y had more 1 H o l l i n g s h e a d , A u g u s t B. & H e d l i c h , G. ' S o c i a l S t r a t i -f i c a t i o n and P s y c h i a t r i c D i s o r d e r " , A m e r i c a n S o c i o l o g i c a l  R eview. V o l . XVIII, A p r i l , 1953« pp. 163-170. -23-s t r e n g t b s and more s e c u r i t y t h a n t h o s e f a m i l i e s i n w h i c h no change t o o k p l a c e . 7 . What i s t h e r e l a t i o n s h i p b e t w e e n any change i n f a m i l y f u n c t i o n i n g and t h e t h e r a p i s t s ' r a t i n g o f t h e c a s e ? I n e f f e c t s what we a r e t r y i n g t o g e t a t i s t h e r e l a t i o n s h i p , b e t w e e n t h e t h e r a p i s t s ' p e r c e p t i o n o f change an d t h e f a m i l y ' s p e r c e p t i o n o f c hange. 8 . What i s t h e r e l a t i o n s h i p b e t w e e n any change i n f a m i l y f u n c t i o n i n g and t h e f a m i l y t y p e as d i a g n o s e d by t h e t h e r a p i s t s ? The t h e r a p i s t s have e v o l v e d a c l a s s i f i c a t i o n scheme o f s e v e n f a m i l y t y p e s 1 and we a r e i n t e r e s t e d i n l e a r n i n g i f t h e r e i s any p a r t i c u l a r c o r r e l a t i o n b e t w e e n change i n f a m i l y f u n c t i o n i n g and f a m i l y t y p e . V a l u e A s s u m p t i o n s and A s s u m p t i o n s o f F a c t . I n u n d e r t a k i n g o u r s t u d y , s e t t i n g up the q u e s t i o n n a i r e , a n a l y z i n g t h e d a t a , a n d coming t o c o n c l u s i o n s , we were p w o r k i n g u n d e r two main v a l u e a s s u m p t i o n s . F i r s t l y , we made the a s s u m p t i o n t h a t t h e s i x c a t e g o r i e s o f f a m i l y f u n c t i o n i n g s h o u l d c o n s t i t u t e a n e x h a u s t i v e l i s t and t h a t f a m i l y g r o u p t h e r a p y s h o u l d aim f o r some change i n some o f t h e s e a r e a s . T h e r e f o r e , a f a m i l y comes i n t o t h e r a p y b e c a u s e one o r more o f t h e s e a r e a s i s m a l f u n c t i o n i n g and i s t h u s c a u s i n g s t r e s s on t h e o t h e r a r e a s . We b e l i e v e t h a t by e f f e c t -i n g a change i n one a r e a , t h e g e n e r a l l e v e l o f s t r e s s w i l l be l e s s e n e d . Our s e c o n d v a l u e a s s u m p t i o n s t a t e s t h a t t h e "^See A p p e n d i x V I . T h e s e v a l u e a s s u m p t i o n s were a r r i v e d a t by t h e r e -s e a r c h e r ' s own t h o u g h t s u p p l e m e n t e d by t h o s e o f t h e t h e r a p i s t s . - 2 4 -therapists ought to set out to promote change and improve-ment i n the six categories: (communication and r o l e s ; l n t r a - f a m l l i a l r e l a t i o n s h i p s ; occupation and education s a t i s f a c t i o n ; extended family re l a t i o n s h i p ; use of community resources) and that they should measure success by the extent or degree of change achieved by the family i n treat-ment i n these areas. In t a l k i n g to the therapists they l i s t e d a number of c r i t e r i a they look f o r , including: mother p r e t t i e r , father more spontaneous, laughter and enjoyment i n the family, family l i s t e n i n g to each other, better communication between children and parents, and increased s o c i a l contacts outside the family. We also made three assumptions of f a c t . In the f i r s t , we assumed the equal competance of the three therapists involved, and that they use the same general c r i t e r i a of family functioning. We also assume that the ratings they give on each case should be r e l i a b l e and v a l i d to a s a t i s -factory degree. Although there i s one p s y c h i a t r i s t and two s o c i a l workers on the team, they have a l l been working on family group therapy f o r the same period of time and have shared many of t h e i r experiences and thus we f e e l are of equal competance i n t h i s f i e l d although t h e i r i n d i v i d u a l techniques may vary. I t i s necessary f o r us to make thi s assumption i f we are to be able to look at a cross sample of a l l the cases. However, we should l i k e to note that because of the d i s t i n c t i v e p e r s o n a l i t i e s of the therapists, we would hesitate to generalize our findings to other s i t u a t i o n s . Secondly, we make the broad assumption that the respondents 1 r e p l i e s should be reasonably accurate and -25-and t r u t h f u l . We have given a l l the married couples a short questionnaire which measures the amount of agreement between them. This we plan to use as a form of r e l i a b i l i t y t e s t . We further assume that opinion data from family members who received treatment ought to provide information pertinent to the measurement of outcome. O u t l i n e o f t h e S t u d y ..Report. T h i s r e s e a r c h r e p o r t i s organized i n t h e f o l l o w i n g way. C h a p t e r I I , e n t i t l e d " M e t h o d o l o g y of t h e S t u d y " , d e s c r i b e s t h e l e v e l o f r e s e a r c h d e s i g n chosen for t h e s t u d y , t h e s a m p l i n g p r o c e d u r e s used,, an d t h e methods o f g a t h e r i n g d a t a . C h a p t e r I I I , e n t i t l e d " A n a l y s i s of t h e f i n d i n g s ' " d e s c r i b e s the m a j o r f i n d i n g s i n e a c h o f t h e s i x s e c t i o n s o f d a t a a n a l y s i s . C h a p t e r IV, entitled,"Summary and C o n c l u s i o n s " , c o n t a i n s a summary o f t h e m a j o r f i n d i n g s o f t h e s t u d y , t h e c o n c l u s i o n s drawn f r o m t h e s e f i n d i n g s , and t h e r e c o m m e n d a t i o n s f o r f u t u r e e n d e a v o u r i n t h e a r e a o f f a m i l y g r o u p t h e r a p y . A u t h o r s h i p .of R e p o r t . The f o l l o w i n g l i s t i n d i c a t e s t h o s e pages o r s e c t i o n s o f t h e t e x t d e a l t w i t h e x c l u s i v e l y by i n d i v i d u a l members o f t h e g r o u p . The r e m a i n d e r o f t h e t e x t was t h e r e s u l t o f c o l l a b o r a t i o n b etween g r o u p members 0 C. A k i n R. D l i n C. F o r s t pp. 26-29; 54-65. pp. 20-25; 29-31; 86-98. pp. 11-=I6; 74=79. pp. 46-54; 65-73. pp. 8-11; 98-106. pp. 16-20; 79-86. Ko L e v i t t C. S m i t h J . Yee CHAPTER I I METHODOLOGY OF THE STUDY L e v e l o f R e s e a r c h D e s i g n . I n c h o o s i n g a l e v e l o f r e s e a r c h d e s i g n t h e a u t h o r s w i l l t a k e t h r e e f a c t o r s i n t o c o n s i d e r a t i o n . The f i r s t , a nd most v i t a l c o n s i d e r a t i o n i s t h a t t h e r e i s no p r e v i o u s r e s e a r c h i n t h i s a r e a ( a s m e n t i o n e d i n a p r e v i o u s s e c t i o n ) . Hence, a d e s i g n w i t h b r o a d s c o p e w i l l be u s e d , s i n c e t h e n a t u r e o f t h i s s t u d y i s p r i m a r i l y e x p l o r a t o r y - f o r m u l a t i v e , I n t h a t i t s e e k s t o g a i n i n s i g h t s a nd g e n e r a t e h y p o t h e s e s f o r f u t u r e s t u d i e s w i t h n a r r o w e r f o c i . F o r t h i s r e a s o n i t i s t h o u g h t t h a t t h e c a s e s t u d y method w i l l be more a p p r o p -r i a t e b e c a u s e i t a f f o r d s t h e o p p o r t u n i t y t o s t u d y t h e i n d i v i d u a l c a s e a t g r e a t e r d e p t h and t h o r o u g h n e s s , e v e n t h o u g h p r e c i s i o n and v a l i d i t y o f f i n d i n g s must be s a c r i f i c e d by t h e s m a l l e r s a mple. I n a d d i t i o n , t h e c a s e s t u d y method has been c h o s e n b e c a u s e o f i t s u n s t r u c t u r e d a s p e c t s . A l t h o u g h t h e a u t h o r s have d e v i s e d a n i n t e r v i e w s c h e d u l e w i t h f o c u s e d q u e s t i o n s ; many o f t h e q u e s t i o n s a r e of a n open-ended n a t u r e m a i n t a i n i n g a b r o a d s c o p e . The d e s i g n o f t h e i n t e r v i e w i t s e l f w i l l a l l o w s u f f i c i e n t o p p o r t u n i t y f o r i n c l u s i o n o f t h e i n t e r v i e w e r ' s i m p r e s s i o n s . A s e c o n d c o n s i d e r a t i o n i n d e c i d i n g t h e d e s i g n o f r e s e a r c h i s t h e n a t u r e o f t h e sa m p l e . The p u r p o s e o f t h e s t u d y i s t o p r o v i d e f o l l o w - u p i n f o r m a t i o n on a g r o u p o f c a s e s a l r e a d y t r e a t e d . S i n c e s y s t e m a t i c d o c u m e n t a t i o n d e s c r i b i n g t h e p o p u l a t i o n o f c a s e s was n o t u n d e r t a k e n a t t h e o n s e t o f t r e a t m e n t , t h e c o n c l u s i o n s o f o u r s t u d y w i l l have t o be drawn on a n ex p o s t f a c t o b a s i s . T h i s w i l l r e d u c e t h e d e s i r a b i l i t y o f u s i n g a d e s c r i p t i v e s t u d y b e c a u s e a s s e s s m e n t o f t h e changes w h i c h may have b e e n b r o u g h t a b o u t by t r e a t m e n t w i l l be l a r g e l y l e f t t o t h e a u t h o r s 8 and t o t h e c l i e n t s 1 i m p r e s s i o n s , and w i l l n o t be b a s e d on f i r m l y o b s e r v a b l e c r i t e r i a . S i m i l a r l y , no c o n t r o l g r o u p was drawn a t t h e i n i t i a t i o n o f t r e a t m e n t t h e r e f o r e o b s e r v a t i o n s c a n n o t be made on t h e b a s i s o f c o m p a r i s o n . F i n a l ly„ c o n s i d e r a t i o n must be given, t o e x p e d i e n c y o f t i m e u t i l i z a t i o n . B e c a u s e t h e a u t h o r s a r e s t u d e n t s i n v o l v e d i n a c u r r i c u l u m l i m i t e d t o e i g h t months d u r a t i o n and r e q u i r -i n g work i n o t h e r a r e a s , t i m e w i l l a l l o w s t u d y o f o n l y a s m a l l sample. F o r t h e same r e a s o n , t h e a u t h o r s w i l l be u n a b l e t o f a m i l i a r i z e t h e m s e l v e s w i t h , and p e r f o r m more e l a b o r a t e f o r m s o f d a t a a n a l y s i s , i n s u c h a s h o r t t i m e . I n a d d i t i o n s t h e e i g h t months t i m e l i m i t on t h e s t u d y o b v i o u s l y w i l l r u l e o u t u s e o f a l o n g i t u d i n a l s t u d y w h i c h w o u l d r e q u i r e a t l e a s t one y e a r a t t h e minimum, i n t h e a u t h o r s ' e s t i m a t i o n . C o n t r o l o f I n t e r f e r i n g V a r i a b l e s . I n t h e c h o i c e o f d a t a c o l l e c t i o n some e f f o r t w i l l be made t o c o n t r o l f o r i n t e r f e r i n g v a r i a b l e s . The s e m i -s t r u c t u r e d i n t e r v i e w s c h e d u l e w i l l p r o v i d e a d e g r e e o f c h e c k i n g r e l i a b i l i t y . By f o c u s i n g on g e n e r a l a r e a s o f f a m i l y f u n c t i o n i n g p r e d e t e r m i n e d by t h e a u t h o r s , t h e e f f e c t s -28-o f i n t e r v i e w e r b i a s and u n r e l i a b i l i t y o f t h e c l i e n t ' s i m p r e s s i o n s may be somewhat r e d u c e d . A t e s t f o r r e l i -a b i l i t y w i l l a l s o be i n t r o d u c e d by t h e i n c l u s i o n o f a s t a n d a r d i z e d t e s t w i t h i n t h e I n t e r v i e w s c h e d u l e . 1 An e f f o r t has been made t o d e t e r m i n e w h e t h e r t h e r e i s a n " e x p e r i e n c e d c o n n e c t i o n " i n t h e c l i e n t ' s mind b e t w e e n changes i n f a m i l y f u n c t i o n i n g and f a m i l y g r o u p t h e r a p y . T h i s k i n d o f e v i d e n c e i s u s e f u l a s shown by Komorovsky and 2 o t h e r s . T h i s w i l l r e d u c e t h e l i k e l i h o o d t h a t s p u r i o u s r e l a t i o n s h i p s b e t w e e n changes and t h e e f f e c t s o f t r e a t m e n t w i l l be a c c e p t e d a l t h o u g h i t may i n c r e a s e t h e p o s s i b i l i t y o f a "honey e f f e c t " , whereby a c l i e n t may be e n c o u r a g e d t o p l e a s e t h e i n t e r v i e w e r w i t h a p o s i t i v e r e s p o n s e . C o n t a m i n -a t i o n w i l l be a v o i d e d t o a c e r t a i n d e g r e e by a l l o w i n g t h e i n t e r v i e w e r s no knowledge b e f o r e h a n d o f t h e c a s e s t o be i n t e r v i e w e d , p r i o r t o t h e i n t e r v i e w . P l a n o f D a t a A n a l y s i s . The f o r m o f a n a l y s i s i s s i m p l e s u m m a r i z a t i o n o f t h e main t r e n d s ( a s seen, by t h e a u t h o r s ) r e l a t e d t o e a c h o f t h e s t u d y q u e s t i o n s . F i r s t l y , t h e a u t h o r s i n t e n d t o compare t h e t h e r a p i s t s ' i m p r e s s i o n s o f t r e a t m e n t p r o g r e s s w i t h t h o s e o f t h e r e s e a r c h e r i n t e r v i e w s . D i s c r e p a n c i e s o r c o n s i s t e n c i e s 1 K e r k h o f f . A l a n C. " N u c l e a r and E x t e n d e d F a m i l y R e l a t i o n s h i p " i n E . Shanas and C. F. S t r e i t s , ( e d . ) 5 S o c i a l  S t r u c t u r e and t h e Family., P r e n t i c e H a l l , New J e r s e y ; 1 9 6 5 . 2 K o m o r o v s k y , M. "The unemployed Man and h i s F a m i l y , " i n P a u l F. L a z a r s ^ e l d , The Language o f S o c i a l R e s e a r c h ; A R e a d e r i n t h e M e t h o d o l o g y o f S o c i a l R e s e a r c h , G l e n c o e , I l l i n o i s ; F r e e P r e s s , 1 9 5 5 ° -29 -here may be of some si g n i f i c a n c e . Secondly, attention w i l l be given to the question of how these changes were maintained through time. This w i l l be a pertinent question i n provid-ing speculations about the l a s t i n g e f f e c t s of changes produced by family group therapy. Thir d l y , the authors intend to examine the s p e c i f i c changes which are suggested as a r e s u l t of treatment. In other words, information as to what kinds of changes are produced, and i n what areas of s o c i a l function-ing they occur, which w i l l be valuable i n the production of hypotheses concerning v i t a l areas of s o c i a l functioning and t h e i r r e l a t i o n to treatment. Analysis w i l l also be focused on the comparison of fam-i l y attributes with change. Hence family type, family structure, symptom category and so on, can be related to the various changes i n order to determine which family a t t r i b u t e s are most amenable to treatment. Simple tabular analysis w i l l be made of any tendencies, g e n e r a l i t i e s or typologies which occur i n the relationships between the dependent and independent variables. Sampling Procedures. 1 The population from which our sample was chosen consisted of a l l those families who were seen and closed between A p r i l 1st, 1964 and March 31st, 1965. This consisted only of those cases seen by Team B of the Mental Health Centre. It i s i n t e r e s t i n g to look at how the cases were given to the three therapists from Intake, the only requirement being that the i d e n t i f i e d patient by over nine Polansky, op. c i t . . chap, i i -30-years of age. We f e l t that there were a large number of variables over which we had not control and which we believe affected the population even before i t reached the treat-ment team. The variables included the socio-economic l e v e l of the family which we believe would i n part determine father's a b i l i t y to attend therapy. Another would be the distance of the family from the c l i n i c . a s i t has been found that there i s a d e f i n i t e concentration of cases from Burnaby and surrounding area. Yet another variable might be the motivation of a l l family members to attend family group therapy which might i n part be connected with the l a s t variable which i s the source of r e f e r r a l . We were given a l i s t of 107 names of people seen between A p r i l , 1 9 6 4 and March, 1 9 6 5. We decided to set the sample size at 24 which would mean four interviews each, choosing this small a number, a f t e r considering that the length of our questionnaire could e a s i l y run over two hours i n i t s administration. Another reason was our decision to take the case study approach i n our thesis. Since the names were given us arranged over a time sequence, we wanted to avoid skewing our sample i n any one time period. Therefore, we arranged the names alphabetically and chose every fourth case, giving us a sample of 2 5 . Vie then chose every f i f t h case to make up our reserve l i s t of 18 cases. Each worker was given four names and three reserves to be used i f contact was not made or i f the families refused to be interviewed. However, i t was at t h i s point that we began to run into a number of d i f f i c u l t i e s with our sample. Some of the - 3 1 -names given us had not been seen in family therapy and a number had only been seen for one assessment interview. This fact, plus t h e fact that a large proportion of our sample size refused to be interviewed, forced us into tracing more names than we had originally intended. In fact we f i n a l l y had to settle on a sample size of 18 cases. In view o f the d i f f i c u l t i e s we were running into in getting our sample size, we decided to look at those people who had refused to take part in our study and who offered some reason. Thus we had a f i n a l l i s t of 54 names, 18 of whom we interviewed and the remaining 36 cases who refused and gave their reasons for doing so. We w i l l thus be able to give some detailed consideration to the refusals and perhaps make a few hypotheses after we examine our findings. Source of Data; (a) Agency Files - Each case studied had a f i l e set up at the time of opening at the Mental Health Centre. The f i l e s varied in completeness but for the most part'included an original diagnostic assessment made upon intake. The intake assessment was made in most cases by the psychiatrist and included more psychiatric than social information. Usually a diagnosis of family type was made by the psychiatrist using a nomenclature unique to their particular team. Each subsequent interview was usually recorded. The length and depth of the recording varied greatly depending on the case and the therapist. In cases where the f i r s t diagnostic interview was also the last no other recording - 3 2 -aside from a usually very brief closing summary was made. Cases which continued over two or more interviews usually contained a closing summary. In the most part the summaries included a very brief note evaluating the outcome of therapy. In some cases closing summaries dealt for the most part with reasons why the therapist f e l t the family was dropping out. In a l l cases identifying information from the face sheet was available from agency f i l e s . In order to equalize as much as possible the impressions gained from the interview and to remain objective during the intervieitf we read only identifying information before the interview. (b) Interviews - A l l available families included in the sample were interviewed by one of the researchers. The f i r s t group of families were approach i n i t i a l l y by tele-phone. Many families f e l t very negatively toward the caller. They f e l t that our connection with the Mental Health Centre was not firmly enough established and they resented their names being given out. As so many families were unwilling to co-operate i t was f e l t that a letter of introduction from the Mental Health Centre prior to the c a l l would be most useful. It was subsequently arranged that Mr, Don Ricketts s Social Work Supervisor for the Mental Health Centre swouid send a l l families involved a letter requesting co-operation, (see Appendix I). It was fe l t by most of the callers that the letter made the explanation of our project much easier and the families - 3 3 -were more w i l l i n g t o c o - o p e r a t e . I t i s d i f f i c u l t t o d e t e r m i n e e x a c t l y how t h e p e r c e n t a g e o f f a m i l i e s a c c e p t i n g i n c r e a s e d w i t h t h e l e t t e r b e c a u s e o f t h e number o f p e o p l e u n a v a i l a b l e f o r o t h e r r e a s o n s , however, a d e c i d e d improvement i n c o -o p e r a t i o n was n o t e d . I t i s p o s s i b l e t h a t some f a m i l i e s were c o n f u s e d o v e r t h e r o l e o f t h e i n t e r v i e w e e s b u t t h i s was n o t t h e m a i n r e a s o n g i v e n . E a c h f a m i l y was i n t e r v i e w e d u s i n g t h e q u e s t i o n n a i r e , ( s e e A p p e n d i x II) f o r s t r u c t u r i n g a f t e r a b r i e f i n t r o d u c t i o n . A l l f a m i l y members were e n c o u r a g e d t o g i v e t h e i r own i n d i v i d u a l o p i n i o n on e a c h q u e s t i o n . I n r e a l i t y , however, i t a p p e a r e d t h a t some young c h i l d r e n p a r t i c u l a r l y were i n f l u e n c e d by p a r e n t s and o t h e r c h i l d r e n . However, f o r t h e most p a r t f a m i l i e s r e a d i l y a n s w e r e d and commented f r e e l y on a l l q u e s t i o n s . The i n t e r v i e w s e n c o u r a g e d comments and d i g r e s s i o n s and r e c o r d e d e v e r y t h i n g t h a t was s a i d i f a t a l l p o s s i b l e . The q u e s t i o n n a i r e was c o m p l e t e d w i t h t h e whole f a m i l y p r e s e n t e x c e p t f o r t h e l a s t two pages w h i c h d e a l t w i t h t h e m a r i t a l r e l a t i o n s h i p . I t was f e l t t h a t t h e p a r e n t s w o u l d f e e l f r e e r t o v e r b a l i z e t h e i r r e a l f e e l i n g s i f t h e c h i l d r e n were n o t p r e s e n t . No p r o b l e m s were e n c o u n t e r e d i n t h i s s e c t i o n . Most p a r e n t s a n s w e r e d f r e e l y . Two one p a r e n t f a m i l i e s were i n c l u d e d i n o u r sample and t h i s s e c t i o n was n o t a p p l i c a b l e t o them. A f t e r t h e c o m p l e t i o n o f t h e m a i n q u e s t i o n n a i r e a n anonymous q u e s t i o n n a i r e was g i v e n t o e a c h p a r e n t . T h i s q u e s t i o n n a i r e i s A p p e n d i x I I I . T h i s q u e s t i o n n a i r e a l o n g - 3 4 -w i t h the f i r s t one a r e d e s c r i b e d i n d e t a i l later.''' No d i f f i c u l t y was e x p e r i e n c e d by the p a r e n t s i n a n s w e r i n g t h i s q u e s t i o n n a i r e a l t h o u g h some d i d comment on i t o r wrote i n b r i e f q u a l i f i c a t i o n s . Upon c o m p l e t i o n of b o t h q u e s t i o n n a i r e s the f a m i l i e s were asked i f they had any o t h e r comments and t h e s e were r e c o r d e d o The i n t e r v i e w s on the average l a s t two t o two and one-h a l f hours and proceeded w i t h o u t d i f f i c u l t y , ( c ) T h e r a p i s t s ' I m p r e s s i o n s . As the t h e r a p i s t s ' i m p r e s s i o n s o f s u c c e s s were one of the more i m p o r t a n t independent v a r i a b l e s i t was d e c i d e d t h a t the d a t a on the f i l e was too i n c o n s i s t e n t and i n c o m p l e t e t o be r e l i e d upon f o r the t h e r a p i s t s t o t a l e v a l u a t i o n o f t r e a t -ment. T h e r e f o r e o n l y the i n i t i a l i m p r e s s i o n s were g a i n e d from the f i l e and the t h e r a p i s t s ' i m p r e s s i o n s were made i n r e t r o s p e c t a t the time o f t h i s s t u d y , (see Appendix I V ) . T h e i r i m p r e s s i o n s i n c l u d e d an e v a l u a t i o n of the t h e r a p y as w e l l as an assessment of the f a m i l y a c c o r d i n g t o type i n cases where t h i s was not i n c l u d e d i n the o r i g i n a l n o t e s on assessment,, An i t e m i z e d q u e s t i o n n a i r e was a d m i n i s t e r e d t o each m a r i t a l p a r t n e r and completed s e p a r a t e l y . T h i s t e s t was an e x a m i n a t i o n of c o n j u g a l r o l e r e l a t i o n s h i p s t o d i f f e r e n -t i a t e between j o i n t and s e g r e g a t e d r o l e s i n v o l v i n g a number of d i f f e r e n t c h a r a c t e r i s t i c s . These c h a r a c t e r i s t i c s were i n 1-See p. 3 6 , Hole Performance. -35-terras of a division of labour. 1 "A Likert Scale of normative 2 items, called Task Sharing . . . ." was used, (see Appendix III). The f i r s t part, containing nine specified Items was called "Ideal Task Allocation". We adopted Kerckhoff's behavioural counterpart, as well, which also consisted of nine items. It was entitled "Husband's Participation Index" or who does what specified tasks, (see Appendix III). Scores that were high in "Ideal Task Allocations", " . . . indicated, an acceptance of task sharing by husbands and wives and a low score indicated a preference for task segregation and specialization".3 Again, in scoring actual behaviour a high score on "Husband's Participation Index" indicated a ". . . high degree of household task perform-ance by the husband." It was assumed that the husband took over some of. the responsibility traditionally belonging to the wife. Thus these two measures of conjugal relationship are ". . . measures of normative task sharing and the actual degree of husband's participation in tasks that are traditionally carried cut by wives."5 To the knowledge of the researchers there has not been any extensive degree of validation achieved in previous research other than that 1Herbst„ P. G . "Task Differentiation in the Nuclear Family," In Ni W. Bell and E. F. Vogel, (ed.)., The Family, The Free Press of Glencoe, i960. ^Kerckhoff, op. c i t . . p. 102. 3Ibid. ^Ibld. s p. 103. 5 l b i d . u s e d by K e r c k h o f f . The r e s e a r c h e r s e m p l o y e d K e r c k h o f f ' s s t u d y a s a method o f v a l i d a t i o n f o r t h e a n s w e r s g i v e n t o t h e q u e s t i o n n a i r e d i r e c t e d i n p a r t i c u l a r t o h u s b and and w i f e . Our q u e s t i o n n a i r e , ( s e e A p p e n d i x I I ) i s d i v i d e d i n t o s i x p a r t s . E a c h a r e a r e p r e s e n t s a f a c t o r w h i c h t h e t h e r a p i s t t h o u g h t was i m p o r t a n t i n f a m i l y g r o u p t h e r a p y . They f e l t t h a t e a c h o f t h e s i x f a c t o r s c o u l d have b e e n a r e a s w h i c h w o u l d be i n f l u e n c e d by f a m i l y g r o u p t h e r a p y . The t h e r a p i s t s were I n t e r e s t e d n o t o n l y i n g e n e r a l c h a n g es b u t more p a r t i c u l a r l y i n changes i n c e r t a i n a r e a s . They were a l s o i n t e r e s t e d i n t h e r e l a t i o n s h i p b e t w e e n change i n one a r e a .and change i n a n o t h e r a r e a . I t was f e l t t h a t an o v e r a l l e v a l u a t i o n o f t h e whole q u e s t i o n n a i r e w o u l d g i v e a g e n e r a l -i z e d i m p r e s s i o n o f t h e i m p a c t o f t r e a t m e n t . Hence a p a r t -b y - p a r t , a n a l y s i s would p e r m i t a d e t a i l e d s t u d y o f f a m i l y d y n a m i c s a s t h e y were i n f l u e n c e d by. f a m i l y g r o u p t h e r a p y . D i v i s i o n o f Q u e s t i o n n a i r e : The f a c t o r s were d i v i d e d i n t o two g r o u p s , ( a ) The i n t e r n a l w h i c h i n c l u d e d c o m m u n i c a t i o n , r o l e p e r f o r m a n c e a n d r e l a t i o n s h i p ; and (b) e x t e r n a l s w h i c h i n c l u d e d u s e o f community r e s o u r c e s , i n f o r m a l s o c i a l i z i n g , a n d o c c u p a t i o n and e d u c a t i o n . E a c h a r e a was a s s i g n e d , t o one r e s e a r c h e r t o d e v e l o p q u e s t i o n s b a s e d on t h e l i t e r a t u r e and on t h e t h e r a p i s t s ' interests„ We s h a l l d i s c u s s e a c h a r e a b r i e f l y m e n t i o n i n g t h e s o u r c e s u s e d . As e a c h i n d i v i d u a l a u t h o r w i l l be d i s c u s s i n g t h e i r own a r e a i n d e t a i l i n t h e d a t a a n a l y s i s t h e d e s c r i p t i o n w i l l be v e r y l i m i t e d h e r e . - 3 7 -Occupation and Education 1 The questions in this section were designed to evaluate change in two areas of occupation and education. The f i r s t area was the actual performance of tasks either at work or at school. The therapists and researchers concurred in think-ing that improved family functioning through family group therapy should have a favourable influence on. task perform-ance. This section is designed as one of the objective tests of the extent of carry-over into the external function-ing of improved internal family conditions. The second area included i n this section was the family members relation-ships with those i n authority and with peers.. Here again i t was f e l t that improved family relationships with a resulting increase in feelings-.of - self-worth would - carry over into external relationships with, employers., school friends, etc. Changes in work roles or the assuming of more tasks and responsibilities were, also f e l t to have some possible connection to strengthening feelings of self worth developed through family group therapy. Hole Performance One of the therapists' postulates was that i f family group therapy is successful, then role performance of the individual's Involved w i l l be enhanced. If the role •'-Reiss, A. J . Jr. , Occupations and Social Status, The Free Press of Glencoe, I l l i n o i s ; 1961. Bendix, i i i ne hart and L i p sett, Class. Status and Power. The Free Press of Glencce, I l l i n o i s ; 1953. Bettelheim, Bruno and Sylvester, Emmy. "Parental Occupations and Children's Symptoms," Bell and Vogel, op. c i t . . pp. 499=509. - 3 8 -e x p e c t a t l o n s a r e g i v e n i n o u r s o c i e t y , 1 t h e n a new l e v e l of p e r f o r m a n c e i s a r e s u l t a n t o b j e c t i v e of f a m i l y g r o u p t h e r a p y . I n l i n e w i t h S a t i r ' s notion of s e l f - e s t e e m 2 we p o s t u l a t e d a l o n g w i t h the t h e r a p i s t s t h a t his role per-formance is p o s i t i v e l y , e n h a n c e d then, so t o o w i l l be one's p l a c e within his n u c l e a r f a m i l y . He w i l l be a b l e t o p e r c e i v e a change In terms o f how he f e e l s a b o u t h i s p l a c e in the family and be a b l e t o n o t e changes i n terms o f how he sees his r o l e i n r e l a t i o n to his s i g n i f i c a n t o t h e r s . F i n a l l y , we wished t o see, a s i n e a c h o f t h e other s e c t i o n s , i f the subjects saw any change as b e i n g b r o u g h t a b o u t by a t t e n d a n c e at f a m i l y g r o u p t h e r a p y . F o r m a l Community R e s o u r c e s This section o f t h e q u e s t i o n n a i r e was o r i g i n a l l y d e s i g n e d t o e x p l o r e t h e f a m i l i e s f e e l i n g s a b o u t the M e n t a l H e a l t h Centre. A general q u e s t i o n was a s k e d f i r s t so t h a t t h e f a m i l i e s ' f e e l i n g s a b o u t community a g e n c i e s i n g e n e r a l c o u l d be determined. It was t h o u g h t t h a t their feelings a b o u t ether agencies c o u l d have some i n f l u e n c e on t h e i r i n i t i a l f e e l i n g s a b o u t t h e M e n t a l H e a l t h C e n t r e . The • ^ Z e i d i t c h , J r . M o r r i s . " R o l e D i f f e r e n t i t a t i o n in t h e N u c l e a r F a m i l y : A C o m p a r a t i v e S t u d y , " i n N. W. B e l l and E . F. V o g e l , The F a m i l y . The F r e e P r e s s o f G l e n c o e , I l l i n o i s ; i960. Goode, W. The F a m i l y , P r e n t i c e - H a l l , E n g l e w o o d , New J e r s e y ; 1 9 6 4 , e s p e c i a l l y c h a p s , v i i and i x . W i l l i a m s , Jr., R o b i n M. op. c i t . . pp. 55-73. A l l p o r t , G. W. P a t t e r n , Growth and P e r s o n a l i t y f H o l t , R i n e h a r t , & W i n s t o n , New Y o r k ; 1 9 6 1 , p . 1 8 4 . Maas, H. S t r e s s f u l S i t u a t i o n s and t h e C o n c e p t o f R o l e  E x p e c t a t i o n , U n p u b l i s h e d P a p e r , B e r k e l y . 2 S a t i r , V i r g i n i a . C o n j o i n t Family T h e r a p y . S c i e n c e & B e h a v i o u r Books, I n c . , P a l o A l t o ; 1 9 6 4 , pp. 8 - 1 1 . - 3 9 -q u e s t l o n on change was o f c o u r s e d e s i g n e d t o d i s c o v e r a t t i t u d e s c o n c e r n i n g t h e M e n t a l - H e a l t h C e n t r e , f o r m e d as a r e s u l t o f therapy,.- R e l i g i o n was i n c l u d e d i n t h i s s e c t i o n as a n o t h e r f o r m a l community r e s o u r c e . , G l u e c k ' s s t u d y c n J u v e n i l e D e l i n q u e n t s and t h e i r f a m i l i e s c o n c l u d e d t h a t the c h i l d r e n whose f a m i l i e s were m o d e r a t e l y r e l i g i o u s and where t h e c h i l d r e n a t t e n d e d c h u r c h w i t h t h e p a r e n t s t h a t t h e r e was l e s s , c h a n c e o f d e l i n q u e n c y . . We f e l t t h a t t h i s q u e s t i o n w o u l d e v a l u a t e t h e f a m i l y ' s r e l i g i o u s p a r t i c i p a t i o n and see i f c hanges i n r e l i g i o n were i n . a n y : w a y r e l a t e d . t o f a m i l y 1 g r o u p t h e r a p y . a n d s u b s e q u e n t l y f a m i l y h e a l t h . As t h e t h e r a p i s t s f e l t t h a t g r e a t e r community p a r t i c i p a t i o n and . i n t e r e s t was a n i n d i c a t i o n o f f a m i l y g r o w t h - t h e l a s t q u e s t i o n ' on o r g a n i z e d c l u b s a n d . g r o u p s was. i n c l u d e d . E x t e r n a l F a m i l y R e l a t i o n s h i p s and  Use o f I n f o r m a l Community R e s o u r c e s In t h e a r e a o f f a m i l y ' v i s i t i n g i t was f e l t t h a t a. change e i t h e r up or.down was n o t n e c e s s a r i l y an i n d i c a t i o n o f f a m i l y g r o w th e x c e p t in. t h e f a m i l i e s where, e x t e n d e d • f a m i l y r e l a t i o n s h i p s had b e e n a p r o b l e m ! b e f o r e t h e r a p y . Though a q u a n t i f i v e change;.was; n o t f e l t t o be i m p o r t a n t i t was t h o u g h t t h a t any. change ' In. t h e family's c o n f l i c t s i n . t h i s a r e a w o u l d be v a l u a b l e to m easure. As some f a m i l i e s i n the p o p u l a t i o n had extended family members i n . t h e same h o u s e h o l d , c o n f l i c t s between, g e n e r a t i o n s and c h a n g e s t h e r e i n w o u l d be measured by t h e s e q u e s t i o n s . Q u e s t i o n 4 on the use o f r e c r e a t i o n a l r e s o u r c e s was G l t e c k , S h e l d o n & E l e a n o r , F a m i l y E n v i r o n m e n t & D e l i n q u e n c y , Houghton M i f f l i n Co., B o s t o n ; 196'2.-- 4 0 -intended to measure once again not the quantity of use but the quality. Is the family able to make more effective use of community resources as a result of family group therapy? 1 Communication One of the most c r i t i c a l areas to be studied Is that of communication.2 For Satir,3 communication is the central 4 theme of her therapy and for Bell i t is also important for i t is f e l t that faulty communication leads to family dysfunction. It has been said that man is primarily a communicating animal. People communicate with each other by a great variety of signs, the most obvious of which are the signs systematized in language whether spoken or written. They also communicate by gesture, including the subtle expressive movements of face, eyes, and a l l the body muscles. 1Goode, o o . c i t . . p. 4 4 . Kluchholon s Florence. "Variations in the Basic Values of Family Systems" In Bell & Vogel, op. c i t . . pp. 304-316. Pitts, Jesse. "The Family and Peer Groups" in Bell & Vogel, op. c i t . , pp. 266-286. Alexrod s M. "Urban Structure and Social Participation, 1 1  American Sociological Review. Vol. XXI, No. 1, February, 1956. 9 "Ruesch, J. Therapeutic Communication. New York; Norton, 1961.' ^Satir, op. c i t . , pp. 63-70. ^Bell, J. S. Family Group Therapy. U. S. Public Health Service Monograph N o . 6 4 , Washington, D.C, U.S. Govern-ment Printing Office, 1961. 5 Fisher, Seymour and Mendell, David. "The Communication of Neurotic Patterns over Two and Three Generations," in Bell & Vogel, op. c i t . . pp. 616-622. Giffen, Mary E. et a l , "The Transmission of Superego Defects In the Family" in. Bell & Vogel, op. c i t . . pp. 626-627. ^Watzlawick, Pau1. An Anthology of Human Communication, Palo Alto Medical Research Foundation, Palo Alto, California; 1964. -41-A t t h i s p o i n t l e t us f i r s t s t a t e t h r e e b a s i c p r e m i s e s o f t h e t h e o r y o f human c o m m u n i c a t i o n . 1 The f i r s t sounds a l m o s t t o o s i m p l e f o r i t s t a t e s t h a t "One c a n n o t Not communicate" E v e n s i l e n c e a s a r e s p o n s e i s o n l y one o f a number o f t y p e s o f n o n - v e r b a l c o m m u n i c a t i o n . As s t a t e d i n t h e p r e v i o u s p a r a g r a p h t h e s t u d y o f c o m m u n i c a t i o n i n c l u d e s t h e t o t a l f i e l d o f v e r b a l and n o n - v e r b a l m e s sages. The s e c o n d p r e m i s e s t a t e s t h a t human c o m m u n i c a t i o n i s a m u l t i - l e v e l phenomenon, and t h a t c o m m u n i c a t i o n becomes m e a n i n g l e s s when r e d u c e d t o one l e v e l , t h a t i s t a k e n o u t o f c o n t e x t . 2 Of p r i m e i m p o r t a n c e i s t h e p r e s e n c e o f u n d e r -s t a n d i n g , f o r w i t h o u t u n d e r s t a n d i n g y ou c a n n o t have c o m m u n i c a t i o n . I f we l o o k a t t h e two a s p e c t s o f commun-i c a t i o n , we f i n d t h e c o n t e n t w i t h i t s i n f o r m a t i o n v a l u e , and s e c o n d l y t h e r e i s t h e a s p e c t w h i c h d e f i n e s b o t h what t h e •"'message i s a b o u t and how i t s s e n d e r c o n c e i v e s o f h i s r e l a t i o n s h i p w i t h t h e . r e c e i v e r . The l a t t e r a s p e c t i s r e f e r r e d t o by R u e s c h as M e t a - c o m m u n i c a t i o n — c o m m u n i c a t i o n a b o u t c o m m u n i c a t i o n . 3 V i r g i n i a S a t i r t a k e s t h i s concept-.- : f u r t h e r by s t a t i n g t h a t m e t a - c o m m u n i c a t i o n c o n v e y s t h e s e n d e r ' s a t t i t u d e t o w a r d t h e message he j u s t s e n t , h i s a t t i t u d e t o w a r d s h i m s e l f , and l a s t l y , t h e s e n d e r ' s a t t i t u d e , •^Bryenton, J . G. "Co m m u n i c a t i o n w i t h C h i l d r e n , " M a s t e r o f S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h C o l u m b i a S c h o o l o f S o c i a l Work, 1954, p. 2. 2 I b i d , ^ R e u s c h , J . and K e e s , W. N o n v e r b a l C o m m u n i c a t i o n : N o t e s on t h e V i s u a l P e r c e p t i o n o f Human R e l a t i o n s . U n i v e r s i t y o f C a l i f o r n i a P r e s s , B e r k e l y ; 1964, p . 6. - 4 2 -f e e l i n g s , , i n t e n t i o n s t o w a r d s t h e r e c e i v e r . 1 T h i s a l l o w s us t o move on t o t h e t h i r d p r e m i s e o f human c o m m u n i c a t i o n w h i c h s t a t e s t h a t t h e message s e n t i s 2 n o t n e c e s s a r i l y t h e message r e c e i v e d . A t y p i c a l p a t h o l o g y o f i n t e r a c t i o n i n v o l v e d h e r e i s t h e p a r t n e r s ' r e s p e c t i v e b l i n d n e s s f o r t h e a c t u a l s e q u e n c e o f c o m m u n i c a t i o n s , so t h a t e a c h o f them c o n s i d e r s h i s b e h a v i o u r as a r e a c t i o n t o t h a t o f t h e o t h e r , b u t r e m a i n s b l i n d t o t h e f a c t t h a t h i s b e h a v i o u r i s a s t i m u l u s and r e i n f o r c e m e n t . An i m p o r t - . a n t c o n c e p t i n t h i s a r e a i s t h e i d e a o f f e e d b a c k w h i c h r e f e r s t o t h e p r o c e s s o f c o r r e c t i o n t h r o u g h i n c o r p o r a t i o n o f i n f o r m a t i o n a b o u t t h e e f f e c t s h i s message a c h i e v e d . F e e d b a c k o f i n f o r m a t i o n t h u s becomes a s t e e r i n g d e v i c e upon w h i c h l e a r n i n g and c o r r e c t i o n o f e r r o r s and m i s -u n d e r s t a n d i n g s a r e b a s e d . ^ S i n c e p e o p l e b e g i n t o work o u t t h e n a t u r e o f t h e i r r e l a t i o n s h i p the moment t h e y meet, by t h e t i m e a r e l a t i o n s h i p h a s d e v e l o p e d o v e r s e v e r a l y e a r s , a s e t o f r u l e s has come i n t o b e i n g . T h e s e r u l e s e n s u r e t h e s t a b i l i t y o f t h e s y s t e m , i n o u r c a s e , the f a m i l y . Don J a c k s o n i n t r o d u c e d t h e term 4 " f a m i l y h o m e o s t a s i s " t o c o v e r t h i s c o n c e p t . One o f t h e most f r e q u e n t c o m p l a i n t s made by p e o p l e who seek h e l p i s t h e f e e l i n g o f b e i n g m i s u n d e r s t o o d b e c a u s e o f l a c k o f , o r b reakdown i n . c o m m u n i c a t i o n among f a m i l y members. It has " ^ S a t i r , op. c i t . . p . 76. 2 W a t z l a w i c k , op. c i t . . p. 5. -'Ruesch ; N o n - V e r b a l C o m m u n i c a t i o n , p . 7. 4 Watzlawick,, op. c i t . , p. 5' -43-b e e n f o u n d t h a t a p p r o p r i a t e c o m m u n i c a t i o n may n e v e r have e x i s t e d or may have b e e n o b t a i n e d on some a r e a s o f l n t r a -f a m i l i a l r e l a t i o n s h i p s and n o t i n o t h e r s i g n i f i c a n t o n e s . I t has b r o k e n dox^n i n a l l a s p e c t s o r may s t i l l be i n t a c t i n some. People, may d e s c r i b e a f a i l u r e i n some c r u c i a l a r e a . P a t t e r n s o f c o m m u n i c a t i o n may be s i m i l a r o r d i f f e r e n t f o r d i f f e r e n t f a m i l y members o r may be p e r v a s i v e i n t h e f a m i l y u n i t . 1 As a r e s u l t o f t h e r a p y i t was f e l t by t h e r e s e a r c h e r s and t h e r a p i s t s t h a t : (1) c o m m u n i c a t i o n , b o t h v e r b a l and n o n -v e r b a l would be more e x p l i c i t ; (2) c o m m u n i c a t o r s w o u l d p e r -c e i v e t h a t they are u n d e r s t o o d and had a c h a n c e t o s p e a k ; (3) t h e r e would be s p e c i f i c o p p o r t u n i t i e s f o r c o m m u n i c a t i o n ; and (4) t h e r e w o u l d be c o n s i d e r a t i o n s o f o t h e r ' s f e e l i n g s when one member v e r b a l l y r e p r i m a n d e d another.. F a m i l y members wo u l d be asked i f and when t h e y n o t i c e d a change i n t h e i r , s u b j e c t i v e i m p r e s s i o n s a b o u t c o m m u n i c a t i o n a n d i f t h i s change was a s s o c i a t e d " I n t h e i r mind" w i t h a n y t h i n g t h a t happened i n f a m i l y group t h e r a p y . I n t r a - f a m l l l a l : R e l a t i o n s h i p s I n a t t e m p t i n g t o e v a l u a t e t h e q u a l i t y o f r e l a t i o n s h i p w i t h i n a f a m i l y we f e l t t h a t i t was n e c e s s a r y t o ch o o s e one p a r t i c u l a r a r e a which would be a f f e c t e d by a change i n r e l a t i o n s h i p . The amount of a g r e e m e n t and d i s a g r e e m e n t w i t h i n the f a m i l y and t h e a l l i a n c e s w h i c h f o r m e d a r o u n d d e c i s i o n - m a k i n g were f e l t t o be h i g h l y i n d i c a t i v e o f t h e f a m i l y members r e l a t i o n s h i p s w i t h e a c h o t h e r . One o f t h e 3-Sherz, F r a n c e s . " F a m i l y I n t e r a c t i o n : Some P r o b l e m s & I m p l i c a t i o n s f o r Casework," E g o - O r i e n t e d Casework, e d . P a r a d , H & M i l l e r , R. F a m i l y S e r v i c e A s s o c i a t i o n , o f A m e r i c a , New Y o r k ; 1963, pp„ 129-144. - 4 4 -a r e a s w orked on p a r t i c u l a r l y i n t h e a c t u a l t r e a t m e n t s e s s i o n s was i d e n t i f i c a t i o n a n d e l i m i n a t i o n o f f a m i l y s c a p e g o a t s . 1 It was f e l t t h a t q u e s t i o n 3 w o u l d e v a l u a t e t h e i n f l u e n c e f a m i l y g r o u p t h e r a p y h a d on t h e p o s i t i o n o f a s c a p e g o a t i n t h e f a m i l y . The " p a r e n t s o n l y " p a r t o f t h e r e l a t i o n s h i p s e c t i o n was d e s i g n e d a s t h e r e s u l t o f a p a r t i c u l a r i n t e r e s t on t h e p a r t o f t h e t h e r a p i s t s i n t h e s e x u a l r e l a t i o n s h i p w i t h i n t h e m a r r i a g e . They f e l t t h a t i f f a m i l y g r o u p t h e r a p y was s u c c e s s -f u l one o f t h e c h a n g es s h o u l d have b e e n a n i m p r o v e d s e x u a l r e l a t i o n s h i p a s a r e s u l t o f b e t t e r m a s c u l i n e a n d f e m i n i n e i d e n t i f i c a t i o n a n d a g e n e r a l improvement o f r e l a t i o n s h i p . 2 H a v i n g p a r e n t s d e v e l o p a r e a l i s t i c o u t l o o k on t h e i r m a r i t a l r e l a t i o n s h i p i s a n o t h e r e x p e c t e d r e s u l t o f s u c c e s s f u l f a m i l y g r o u p t h e r a p y . Q u e s t i o n 7 was d e s i g n e d t o e v a l u a t e any c h a n g e s i n t h i s a r e a . As f a m i l y g r o u p t h e r a p y s t r e s s e s , v e r b a l c o m m u n i c a t i o n a s a p r o b l e m s o l v i n g p r o c e s s q u e s t i o n s 5 and 6 were i n c l u d e d t o measure n o t o n l y a r e a s o f d i f f i c u l t y b u t methods an d c h a n g e s i n t e c h n i q u e s o f p r o b l e m s o l v i n g . Upon a s s i g n m e n t o f e a c h r e s e a r c h e r t o a s p e c i f i c t o p i c , q u e s t i o n s , b o t h o b j e c t i v e a n d s u b j e c t i v e were c o m p i l e d and o r d e r e d . T h e s e q u e s t i o n s were d i s c u s s e d a t t h e s i s g r o u p m e e t i n g s w i t h t h e t h e s i s a d v i s o r . Q u e s t i o n s were r e v i s e d 1 Ackerman, N. W. The P s y c h o d y n a m i c s o f F a m i l y L i f e , B a s i c B ooks, New Y o r k ; 1958. B e l l and V o g e l , op. c i t . , p. 382. 2 S a t i r , op. c i t . -45-and t h e f i r s t d r a f t o f t h e q u e s t i o n n a i r e was p r e - t e s t e d 1 on a f a m i l y , r e c e n t l y i n f a m i l y g r o u p t h e r a p y a t t h e B u r naby M e n t a l H e a l t h C l i n i c . One o f t h e r e s e a r c h e r s i n t e r v i e w e d t h e f a m i l y w h i l e t h e o t h e r r e s e a r c h e r s f i l l e d o u t t h e q u e s t i o n -n a i r e . T h i s was done t o p r o v i d e c o n s i s t e n c y i n r e s e a r c h e r i n t e r v i e w i n g t e c h n i q u e , t o p r o v i d e a s t a n d a r d i z e d s c o r i n g o f r e s p o n s e s , and t o g i v e t h e f a m i l y b e i n g i n t e r v i e w e d a c h a n c e t o c r i t i c i z e t h e w o r d i n g o f t h e q u e s t i o n s i n terms o f c l a r i t y , c o m p r e h e n s i v e n e s s , b o t h f o r a d u l t s and c h i l d r e n . F o l l o w i n g t h e p r e t e s t t h e q u e s t i o n n a i r e was r e v i s e d w i t h c e r t a i n s e c t i o n s and q u e s t i o n s b e i n g d e l e t e d o r a d d e d . D i s c u s s i o n s a g a i n t o o k p l a c e i n t h e s i s g r o u p m e e t i n g s t o c h e c k and r e v i s e t h e q u e s t i o n n a i r e t o i t s f i n a l f o r m . ( S e e A p p e n d i x I I ) . The s c h e d u l e was u s e d i n a u n i f o r m manner, a l t h o u g h i n t e r v i e w e r s u s e d a v e n u e s o f e x p l o r a t i o n w h i c h t h e y f e l t may be p e r t i n e n t t o t h e s t u d y . The o n l y a p p a r e n t d i f f i c u l t l y i n t h i s use o f t h e i n t e r v i e w s c h e d u l e was t h e d i s s e m i n a t i o n o f t h e wide r a n g e . o f i n f o r m a t i o n w h i c h was g a i n e d i n t h i s way. 1 G o o d e , W. J . and H a t t , P a u l K. Methods i n S o c i a l  R e s e a r c h . M c G r a w - H i l l Book Co., I n c . , T o r o n t o ; 1952, Chap, i i , e s p e c i a l l y pp. 157-158. CHAPTER II I STUDY FINDINGS R e l i a b i l i t y Study of Husbands Wife Task Sharing Data. The husband-wife questionnaire was divided into two sections; the f i r s t aimed at ascertaining the normative acceptance of task sharing between husband and wife i n d a i l y a c t i v i t i e s . "A high score indicated an acceptance of task sharing by husbands and wives, and a low score indicated a preference for task segregation and s p e c i a l i z a t i o n " . 1 In scoring 1 t h i s question the responses were weighted from 0 to 4 depending on the category of the response. Each weighted score was added independently f o r each spouse and the difference was recorded. By weighting the scores the maximum score that could be obtained was 36 as there were 9 questions altogether. Where the amount of agreement was 30 or more we a r b i t r a r i l y chose those families as having high agreement and where the amount of agreement was 20 or less these families were designated as having low agreement. We f i r s t related the low or high agreement scores to number of interviews suggesting two categories: three or less interviews; and four or more interviews. Second, we related low and high agreement with socio-economic class of family using the Hollingshead Index. Third, we related low Kerckhoff, op. c i t . . p. 102. - 4 ? -a n d h i g h a g r e e m e n t w i t h t h e t h e r a p i s t s ' i m p r e s s i o n s o f no change o r some change i n t h e f a m i l y . F o u r t h , we r e l a t e d h i g h and low agreement w i t h t h e t h e r a p i s t s ' i m p r e s s i o n s o f f a m i l y t y p e a s d e f i n e d i n A p p e n d i x IV. T a b l e 1 i s an o v e r a l l summary o f t h e f i n d i n g s l i s t e d by f a m i l y , t y p e o f agreement, d i s c r e p a n c y s c o r e , 1 number o f i n t e r v i e w s , c l a s s o f f a m i l y , t h e r a p i s t s ' i m p r e s s i o n s and f a m i l y t y p e . From t h i s c o m p r e h e n s i v e t a b l e a l l o t h e r t a b l e s were o r i g i n a t e d . T a b l e 1 . Summary o f f i n d i n g s f o r a l l  18 f a m i l i e s i n t e r v i e w e d Number Fam- o f T h e r a p . F a m i l y i l y A g r e e . D i s c r e p : . I n t e r v . C l a s s I m p r e s s . Type A L. L 13 L Change C o n s t r i c t e d B L H 8 L Change C h a o t i c C L L 6 H Change C o n s t r i c t e d D — 12 L Change N/C^ L e a d e r l e s s E H H 13 L L e a d e r l e s s F - _ 3 H Change C h a o t i c G L H 12 L Change D i c t a t o r i a l H L L 15 H Change L e a d e r l e s s I H L 5 H Change N/C C h a o t i c J I, H 1 L D i c t a t o r i a l K H L 1 H Change L e a d e r l e s s L H H 8 L Change L e a d e r l e s s M H H 6 L Change D i s c o n n e c t e d N H L 7 • H Change D i s c o n n e c t e d 0 H L 24 H N/C~ D i s c o n n e c t e d P H L 20 H Change D i s c o n n e c t e d 0. L H . 1 L N/C C o n s t r i c t e d R H L 7 H Change D i c t a t o r i a l F a m i l i e s D and F a r e one p a r e n t ( M o t h e r ) f a m i l i e s . uNo ch a n g e . As s t a t e d i n T a b l e 2 we t o o k a s c o r e o f 30 o r more as i n d i c a t i v e of h i g h a g r e e m e n t and t h e r e f o r e a s c o r e o f 29 o r F o r a d i s c u s s i o n o f t h i s t e r m see d i s c u s s i o n on "Husband's P a r t i c i p a t i o n I n d e x " w h i c h f o l l o w s t h i s s e c t i o n . - 4 8 -l e s s a s low a g r e e m e n t . Thus i n 9 c a s e s we h a d h i g h a g r e e -ment. On most i t e m s c o u p l e s a g r e e d f a i r l y w e l l taut t h e r e was g r e a t e s t d i s a g r e e m e n t i n t h r e e a r e a s ; husband's p a r t i c i p a t i o n i n housework; s e p a r a t i o n o f h u s b a n d - w i f e t a s k s ; and d i s p e n s a t i o n o f money. T h e s e a r e a r e a s o f g e n e r a l c o n t e n t i o n . We w o u l d s u g g e s t t h a t on t h e one hand h i g h agreement means s p o u s e s , a l t h o u g h h a v i n g c o m p l e t e c o n j u g a l r o l e s e p a r a t i o n may, n e v e r t h e l e s s , have a c c u r a t e knowledge o f t h e i r mate's p a r t i c i p a t i o n . On t h e o t h e r hand> as agreement s c o r e becomes s m a l l e r i t m i g h t i n d i c a t e l e s s knowledge o f what t h e o t h e r i s a c t u a l l y d o i n g . I n a d d i t i o n , i t m i g h t i n d i c a t e some o v e r - e s t i m a t i o n o r u n d e r - e s t i t r a t i o n o f one's own p a r t i c i p a t i o n o r e v e n i n a c c u r a c y i n commun-i c a t i n g one's t a s k a c c o m p l i s h m e n t s t o h i s o r h e r s p o u s e . T a b l e 2 . F r e q u e n c y D i s t r i b u t i o n o f Agreement S c o r e s Between Husband and W i f e on C o n j u g a l R o l e R e l a t i o n s h i p s N= l 6 (Maximum P o s s i b l e Agreement S c o r e : 3 6 ) . Agreement Number o f S c o r e C a s e s 0-6 7-12 13-18 1 9 - 2 4 25-30 31-36 B e c a u s e a g r e e m e n t , f o r t h e most p a r t , i s r e l a t i v e l y h i g h and b e c a u s e t h e h u s b a n d - w i f e q u e s t i o n n a i r e was f i l l e d o u t i n d e p -e n d e n t l y i t c o u l d be s a i d t h a t t h i s i s a f a i r l y r e l i a b l e i n s t r u m e n t . T h e r e a p p e a r s t o be a r e l a t i o n s h i p b e t w e e n h i g h -49-agreement on t a s k s h a r i n g and f o u r o r more i n t e r v i e w s . F o r a n N o f 16 i t i n c l u d e d 50$ o f t h e c a s e s . I t must be k e p t i n mind t h a t f o u r o r more i n t e r v i e w s may n o t n e c e s s a r i l y c a u s e h i g h a g r e e m e n t b u t p e r h a p s t h e agreement was a l r e a d y e s t a b l i s h e d p r i o r t o t h e r a p y . I f t h i s was t h e c a s e t h e n one m i g h t s a y t h a t w i t h h i g h e r a g r e e m e n t t h e r e i s a g r e a t e r c h a n c e o f s u c c e s s i n f a m i l y g r o u p t h e r a p y . T a b l e 3. T a s k - S h a r i n g a g r e e m e n t as R e l a t e d  t o number o f i n t e r v i e w s N=l6 No. o f I n t e r v i e w s 3 o r l e s s 4 o r more H i g h Agreement 1 8 9 Low Agreement' .2 7 / 3 . 13 16 C o n s i d e r i n g t a s k a g r e e m e n t w i t h • f a m i l y 1 s s o c i o -e c o n o m i c c l a s s membership i t w o u l d appear, t h a t t h e r e i s a h i g h e r a g r e e m e n t w i t h h i g h e r ' c l a s s and l o w e r a g r e e m e n t f o r l o w e r c l a s s . T h i s i s a c l e a r i n d i c a t i o n t h a t h i g h e r c l a s s members a c c e p t t a s k s h a r i n g by b o t h s p o u s e s w h i l e l o w e r c l a s s p e r s o n s show a p r e f e r e n c e f o r s e g r e g a t i o n o f t a s k s and s p e c i a l i z a t i o n . ( S e e T a b l e 4). C o n s i d e r i n g t h e t h e r a p i s t s 1 ' i m p r e s s i o n s o f i m p r o v e -ment o r non-improvement o f f a m i l i e s w i t h a greement o f t a s k s h a r i n g between h u s b a n d and w i f e t h e r e i s an e q u a l s p l i t b etween t h e f o u r c o u p l e s who showed no change. Of t h e 12 -50-Table 4. Task s h a r i n g agreement as r e l a t e d  to S o c i a l C l a s s of Family High Agreement Low Agreement Low C l a s s 8 High C l a s s 8 9 7 16 couples who are supposed, to have shown some change seven of them or 58$ had hi g h agreement. T h i s p e r c e n t i s s l i g h t l y -above change and not n e c e s s a r i l y s i g n i f i c a n t . Table 5' Task s h a r i n g agreement as R e l a t e d t o T h e r a p i s t s ' Impressions of Change d u r i n g Treatment.. High Agreement Low Agreement No Change Some Change 12 9 7 16 When we compare f a m i l y type w i t h agreement between spouses i t appears t h a t d i s c o n n e c t e d f a m i l i e s and l e a d e r -l e s s f a m i l i e s are f i r s t and second, r e s p e c t i v e l y . On the oth e r hand c o n s t r i c t e d f a m i l i e s have the lowest agreement wit h d i c t a t o r i a l f a m i l i e s second i n t h i s category. C h a o t i c f a m i l i e s are s p l i t . T able 6. Task S h a r i n g Agreement as  R e l a t e d to Family Type N=l6 Family Type Leader. C o n s t r i c t . C h a o t i c D i s c o n n e c t . D i e t a t . High Agree. 3 0 1 4 1 9 Low Agree. 1 3 1 0 7 4 3 2 4 3 16 - 5 1 -B e l l a b l l i t y Study; Husband's  P a r t i c i p a t i o n Index. Part two of the questionnaire f l l l e d - o u t independently by husband and wife was aimed at ascertaining "the actual degree of husband's p a r t i c i p a t i o n i n tasks that are tradition' a l l y carried out by wives' 1. 1 We wanted to test the amount of discrepancy between husband and wife on husband's domestic role involvement. Once again i n scoring the responses each item was weighted from 1 to 6 depending on the category of the responses. Each weighted score was added independently fo r each spouse and the difference Was recorded. These differences were added and divided by the number of cases (16) and a mean discrepancy score of 4 . 6 was the dividend. Where the mean was four or less i t was designated as low discrepancy while a mean of f i v e or more was designated as high discrepancy. It might be postulated that as d i s -crepancy increases the amount of r o l e or task expectation decreases. Each spouse may view his a c t i v i t y d i f f e r e n t in terms of his perception or through lack of communication one may not communicate what he has or has not done i n domestic chores. Discrepancy differences scored as high or low are recorded i n Table 1. As before we related high and low discrepancy scores to number of interviews, socio-economic cla s s , therapists' impressions of change, and family type as defined i n Appendix VI. Using high and low discrepancy i n this series of analyses compared with the number of interviews i t appeared Kerckhoff, op. c i t . . p. 103. -52-that i n $0% of the cases there was low discrepancy between spouses. These eight couples as well participated i n four or more interviews. Of thirteen couples having four or more interviews f i v e scored high discrepancy. This might suggest that a greater number of interviews could lead to lower household task segregation on the part of the husband. Lower discrepancy might indicate more communication and more perception of the actual a c t i v i t y of the spouse. Table 7« Discrepancy as Related to  Number of Interviews N=l6 High Discrepancy Low Discrepancy No. of Interviews 3 or less k or more 2 5 1 8 13 16 Comparing class and discrepancy we see a very clear cut and s i g n i f i c a n t r e l a t i o n s h i p . A l l eight of the high class families scored low on discrepancy score of husband's p a r t i c i p a t i o n index. For the low class families seven of them showed high discrepancy. From th i s we might say that higher class persons are encouraged to share domestic tasks and are also encouraged to communicate more about t h e i r a c t i v i t i e s . When communication i s clear this often encourages a very clear understanding in delineating one's tasks. See Table 8. In comparing spouses discrepancy scores with therapists' -53-Table 8, Discrepancy as Related to  Soci a l Class of Family N=l6 Low Class High Class High Discrep. Low Discrep. 7 " 0 . 1 8 8 8 16 impressions about changes there, appears to be some r e l a t i o n -ship again between high discrepancy and no change and between low discrepancy and some change. In three out of four cases showing no change there was high discrepancy. In eight of twelve cases showing some change there was low discrepancy. These findings might suggest that the higher the discrepancy the less w i l l the couple benefit from p a r t i c i p a t i o n i n family group therapy. Conversely, as discrepancy becomes lower more change might be expected from therapy. Table 9. Discrepancy as Related to Therapists' Impressions N=l6 No Change Some Change High Discrep. 3 Low Discrep. 1 .8 12 16 By comparing discrepancy with family type we found that constricted and disconnected families showed lower d i s -crepancy; leaderless and chaotic families were s p l i t ; d i c t a t o r i a l families showed a higher d i f f e r e n t i a l score. Lower discrepancy f o r disconnected families might indicate -54-t h e y w i l l do b e t t e r i n f a m i l y g r o u p t h e r a p y . T h i s was s u g g e s t e d i n T a b l e 6. Where f a m i l y t y p e s a r e s p l i t on d i s c r e p a n c y t h i s m i g h t i n d i c a t e a t l e a s t c hance f o r s u c c e s s i n t h e r a p y . T a b l e 10. D i s c r e p a n c y a s R e l a t e d t o F a m i l y Type N=l6 L e a d e r . C o n s t r i c t . C h a o t i c D i s c o n n e c t . D i e t a t . H i g h D i s c r e p , 2 1 1 1 2 Low D i s c r e p , 2 2 1 3 1 4 3 2 4 3 16 O c c u p a t i o n and E d u c a t i o n . T h i s p o r t i o n o f t h e i n t e r v i e w s c h e d u l e d e a l s w i t h q u e s t i o n s p e r t a i n i n g t o work and s c h o o l . T h e s e two a r e a s were f e l t by t h e a u t h o r s t o b e c o n c e p t u a l l y r e l a t e d i n t h a t t h e y b o t h c o n t a i n e d s e v e r a l common e l e m e n t s p e r t i n e n t t o f a m i l y members' s o c i a l f u n c t i o n i n g i n f o r m a l , t a s k - o r i e n t e d a c t i v i t i e s e x t e r n a l t o t h e f a m i l y . The f i r s t common e l e m e n t i s t a s k p e r f o r m a n c e . B o t h work and s c h o o l i n v o l v e t h e e x p e c t a t i o n o f c e r t a i n l e v e l s o f a c h i e v e m e n t w h e r e i n s t a n d a r d s o f p e r f o r m a n c e a r e s e t l a r g e l y by e x t e r n a l r u l e s . S e c o n d l y , b o t h o f t h e s e s o c i a l i n s t i t u t i o n s i n v o l v e some k i n d o f s a t i s f a c t i o n o r d i s s a t i s f a c t i o n i n terms o f e x t r i n s i c and i n t r i n s i c r e w a r d s as a r e s u l t o f t h e i r p e r f o r m a n c e . T h i r d l y , e a c h u s u a l l y i n v o l v e s r e l a t i o n s h i p s w i t h o t h e r s on a p e e r g r o u p b a s i s o r on a n a u t h o r i t y b a s i s . The l a t t e r i n t e r - r e l a t i o n s h i p s t e n d t o b e on a n i n v o l u n t a r y b a s i s -55-whereby a s s o c i a t i o n i s n e c e s s i t a t e d p r i m a r i l y a s a r e s u l t o f p r a c t i c a l c o n s i d e r a t i o n d e t e r m i n e d by t h e e n v i r o n m e n t . Items i n t h e i n t e r v i e w s c h e d u l e i n t h i s s e c t i o n were . d e s i g n e d t o d e t e r m i n e t h e l e v e l o f p r e s e n t f u n c t i o n i n g and any changes i n f u n c t i o n i n g i n t h e f o l l o w i n g f o u r a r e a s : t a s k p e r f o r m a n c e j t a s k s a t i s f a c t i o n , r e l a t i o n s w i t h a u t h o r i t y , and r e l a t i o n s w i t h p e e r s ; as were m a n i f e s t e d i n t h e r e s p o n s e s o f t h e i n t e r v i e w e e s i n answer t o q u e s t i o n s r e g a r d i n g t h e i r work o r t h e i r s c h o o l s . I n o n l y f o u r f a m i l i e s o f t h e sample o f e i g h t e e n were t h e r e members who r e p o r t e d p o s i t i v e c h a n g es i n t h e s e a r e a s , w h i c h t h e y c o u l d a t t r i b u t e t o f a m i l y g r o u p t h e r a p y . However, when t h e s e f a m i l i e s were compared, i n number of i n t e r v i e w s a t t e n d e d , ( w i t h t h e m e d i a n number o f e i g h t i n t e r v i e w s by the e n t i r e sample), i t i s i n t e r e s t i n g t o n o t e t h a t t h e i r a t t e n d a n c e was as f o l l o w s : e i g h t i n t e r v i e w s , f i f t e e n i n t e r v i e w s ; t w enty i n t e r v i e w s ; and t w e n t y f o u r i n t e r v i e w s . The l a t t e r t h r e e f a m i l i e s r e p r e s e n t t h e t h r e e h i g h e s t numbers o f I n t e r v i e w s a t t e n d e d by a l l f a m i l i e s i n t h e sample. A l l t o g e t h e r t h e r e were s e v e n f a m i l i e s i n w h i c h t h e f o l l o w i n g c r i t e r i a a p p l i e d : one f a m i l y member r e p o r t e d p o s i t i v e change w h i c h he a t t r i b u t e d t o t r e a t m e n t , i n one o r more o f the f o u r a r e a s o f f u n c t i o n i n g ; one f a m i l y member r e p o r t e d p o s i t i v e change I n more t h a n one o f t h e f o u r a r e a s w i t h o u t a t t r i b u t i n g change t o t r e a t m e n t ; o r , more t h a n one f a m i l y member r e p o r t e d p o s i t i v e change i n one o r more o f t h e f o u r a r e a s w i t h o u t a t t r i b u t i n g change t o t r e a t -ment. I n t h i s g r o u p , o n l y one f a m i l y a t t e n d e d f e w e r -56-i n t e r v i e w s ( s e v e n i n t e r v i e w s ) t h a n t h e m edian o f e i g h t . The f o l l o w i n g t a b l e I l l u s t r a t e s t h e t e n d e n c y f o r f a m i l i e s a t t e n d i n g a g r e a t e r number o f i n t e r v i e w s , t o a l s o r e p o r t p o s i t i v e change i n t h e i r work o r s c h o o l . T a b l e 11. Change i n F u n c t i o n i n g a t Work o r S c h o o l as R e l a t e d t o number o f I n t e r v i e w s i n T r e a t m e n t Change E i g h t i n t e r v i e w s Fewer t h a n e i g h t -change 6 1 r e p o r t e d no change 3 8 r e p o r t e d j T o t a l 9 9 * 'There were, d i f f e r e n c e s b e t w e e n t h e g r o u p o f s e v e n t h a t , c h anged and the r e m a i n d e r w h i c h d i d n o t c h a n g e . U s i n g t h e H o l l i n g s h e a d I n dex f o r a two c l a s s s y s t e m o f c a t e g o r i -z a t i o n , b a s e d on o c c u p a t i o n , t h e a u t h o r s compared s o c i o -e c o n o m i c c l a s s w i t h c h a n g e . F o u r o u t o f s e v e n i n t h e g r o u p t h a t . c h a n g e d were c l a s s e d as " h i g h " as compared t o f i v e o u t o f e l e v e n i n t h e g r o u p t h a t d i d n o t r e p o r t c hange; s u g g e s t i n g t h a t t h e r e may be a t e n d e n c y f o r members o f t h e h i g h e r s o c i o - e c o n o m i c c l a s s e s t o change i n t h e s e a r e a s more r e a d i l y t h a n t h o s e I n t h e l o w e r s o c i o - e c o n o m i c c l a s s e s . However, d i f f e r e n c e s were t o o s m a l l t o be s i g n i f i c a n t i n t h i s s ample, 'It I s t h i s a u t h o r s ' i m p r e s s i o n t h a t i f a more s o p h i s t i c a t e d c l a s s i n d e x xvere u s e d t a k i n g i n t o c o n s i d e r a -t i o n , e d u c a t i o n and o t h e r f a c t o r s , more p r o n o u n c e d c l a s s d i f f e r e n c e s would have b e e n a p p a r e n t . P o s s i b l y a t h r e e -57-c l a s s system would r e f l e c t c l a s s d i f f e r e n t i a l s more c o n s i s -t a n t w i t h i m p r e s s i o n s r e c e i v e d by t h e a u t h o r s i n t e r v i e w i n g the r e s p o n d e n t . T a b l e 12. Change i n f u n c t i o n i n g : a t work  o r s c h o o l as r e l a t e d t o C l a s s change H i g h e r C l a s s Lower c l a s s change r e p o r t e d 5 3 no change r e p o r t e d 4 6 T o t a l 9 9 I n c o m p a r i n g f a m i l y t y p e s w i t h changes i n f u n c t i o n -i n g a t home and s c h o o l , i t was f o u n d t h a t " l e a d e r l e s s " f a m i l i e s and " d i s c o n n e c t e d " f a m i l i e s r e p o r t e d g r e a t e r change t h a n d i d ' " d i c t a t o r i a l " " c h a o t i c " , o r " c o n s t r i c t e d " f a m i l i e s . However,, the samples f o r e a c h f a m i l y t y p e were so s m a l l t h a t i t was d i f f i c u l t t o g e n e r a l i z e from the d a t a . I n a d d i t i o n , the f a m i l y t y p e s r e p o r t i n g change a l s o a t t e n d e d more i n t e r v i e w s , , t h e r e f o r e change c o u l d have b e e n a f u n c t i o n of i n t e r - v i e w f r e q u e n c y r a t h e r t h a n f a m i l y t y p e . A n o t h e r p o s s i b i l i t y i s t h a t i n t e r v i e w f r e q u e n c y i s a f u n c t i o n o f f a m i l y ty pe . w i t h t h e r e s u l t t h a t c e r t a i n f a m i l y t y p e s r e m a i n i n t r e a t m e n t l o n g e r . Hence f a m i l y t y p e may be more r e l e v a n t t o drop-out r a t e s r a t h e r t h a n a b i l i t y t o c h a n g e . On t h e o t h e r hand the t h e r a p i s t may be t y p i n g t h e f a m i l y on t h e b a s i s of t h e i r d i f f i c u l t y i n t r e a t m e n t , o r p a r t l y on t h e b a s i s of t h e i r d e g r e e o f f a m i l i a r i t y w i t h t h e f a m i l y due t o d i f f e r e n t i a l p e r i o d s o f i n v o l v e m e n t w i t h them. C o m p a r i s o n o f t h e s e f a c t o r s a r e as f o l l o w s : -58-T a b l e 13» Change I n F u n c t i o n i n g a t Work and S c h o o l as  R e l a t e d t o F a m i l y T y p e s and t h e i r  R e s p e c t i v e I n t e r v i e w F r e q u e n c i e s F a m i l y Type no. p r o p o r t i o n c hanged p o s i t i v e l y p e r c e n t m edian e i g h t i n t e r v i e w s o r more D i c t a t o r i a l 3 1:3 33$ L e a d e r - l e s s 6 1:2 100% C h a o t i c 3 0:3 33^ C o n s t r i c t e d 3 1:3 0 D i s c o n n e c t e d 3 2:3 66% t o t a l 18 7:18 50% S i m i l a r l y when f a t a l l y s t r u c t u r e i s a n a l y z e d , b a s i n g f a m i l y s i z e on t h e number o f f a m i l y members a t t e n d i n g i n t e r -v i e w s , t h e number o f f a m i l i e s a t e a c h I n t e r v a l i s t o o few fr o m w h i c h t o g e n e r a l i z e . F a m i l i e s w i t h f o u r o r more members a t t e n d i n g t r e a t m e n t ( e l e v e n f a m i l i e s ) r e p o r t change more f r e q u e n t l y t h a n t h o s e w i t h f e w e r t h a n f o u r members a t t e n d i n g ( s e v e n f a m i l i e s ) . T a b l e 14. Change i n F u n c t i o n i n g a t Work and S c h o o l  as R e l a t e d t o number o f F a m i l y Members a t t e n d i n g T r e a t m e n t change- f o u r members f e w e r t h a n and above f o u r members change r e p o r t e d 6 1 no change o r e p o r t e d 5 T o t a l 11 7 The a p p a r e n t t e n d e n c y f o r f a m i l i e s w i t h f e w e r members a t t e n d -ing,, t o be less s u c c e s s f u l i n t r e a t m e n t i s c o n s i s t a n t w i t h t h e t h e r a p i s t ' s i m p r e s s i o n s t h a t f a m i l i e s o f two and t h r e e a r e more d i f f i c u l t t o t r e a t t h a n f a m i l i e s w i t h more -59-members a t t e n d i n g t r e a t m e n t . When t h e number o f f a m i l y members a t t e n d i n g t r e a t m e n t i s c o r r e l a t e d w i t h b o t h number o f i n t e r v i e w s and change, f u r t h e r i n t e r - r e l a t i o n s a r e s u g g e s t e d i n s o f a r as t r e a t a b i l i t y i s c o n c e r n e d . F a m i l i e s w i t h f o u r o r more members a t t e n d i n g t h e m e d i a n number o f i n t e r v i e w s o r more, show a much h i g h e r f r e q u e n c y o f change t h a n f a m i l i e s w i t h : f o u r o r more members a t t e n d i n g f e w e r t h a n t h e m e d i a n numbers o f i n t e r v i e w s ; f e w e r t h a n f o u r members a t t e n d i n g more t h a n t h e m e d i a n number o f i n t e r -v i e w s ; or,, f e w e r t h a n f o u r members a t t e n d i n g l e s s t h a n t h e median number o f i n t e r v i e w s . I t i s i n t e r e s t i n g t o n o t e t h a t among t h e f a m i l i e s r e p r e s e n t e d by T a b l e 1 4 , t h e r e was o n l y one f a m i l y " w i t h f o u r o r more members a t t e n d i n g t r e a t m e n t w h i c h r e p o r t e d change a f t e r l e s s t h a n e i g h t i n t e r v i e w s . However, t h i s f a m i l y a t t e n d e d s e v e n i n t e r v i e w s a n d was a member o f t h e h i g h e r c l a s s i n t h e H o l l i n g s h e a d t w o - c l a s s i n d e x o f s o c i o - e c o n o m i c r a t i n g . S i m i l a r l y , t h e o n l y f a m i l y r e p o r t i n g change i n t h e l e s s t h a n f o u r members c a t e g o r y , r e c o r d s t h e s e c o n d h i g h e s t a t t e n d a n c e o f i n t e r v i e w s i n t h e who l e sample ( F a m i l y P ) . The l a t t e r f a m i l y I s a l s o r a t e d i n t h e h i g h e r s o c i o - e c o n o m i c c a t e g o r y . Hence i t a p p e a r s p o s s i b l e t h a t c o n f i g u r a t i o n s o f f a m i l y c h a r a c t e r i s t i c s may emerge as b e i n g d i f f e r e n t i a l l y r e s p o n s i v e t o t h i s t y p e o f t r e a t m e n t . On t h e o t h e r hand many o f t h e s e r e l a t i o n s h i p s may p r o v e t o be s p u r i o u s a f t e r f u r t h e r i n v e s t i g a t i o n . F o r example i t may be f o u n d t h a t f a m i l y s i z e i s r e l a t e d t o c o n t i n u a t i o n i n t r e a t m e n t s o n l y t o t h e e x t e n t o f t h e f a m i l y K. -60-i n c r e a s i n g pressures not to attend, when there are more fa m i l y members unmotivated to attend. Class v a r i a t i o n s i n the s i z e of f a m i l y may a l s o enter i n t o the p i c t u r e , j u s t as they may have d i f f i c u l t y t a k i n g time off work to attend treatment,, Lower c l a s s e s have l a r g e r f a m i l i e s and. hold jobs from which i t i s d i f f i c u l t to take leave. Table 15. Change i n Functioning at Work and School as Related to Number of Family Members  Attending Treatment and Number  of Interviews Attended .Number of fam i l y members act ending-Percent showing change a f t e r e i g h t or more i n t e r v i e w s Percent showing change a f t e r l e s s than e i g h t interviews Four or more 83$ 20$ Less than four 25%. 0 Other c h a r a c t e r i s t i c s of family s t r u c t u r e such as one parent f a m i l i e s and f o s t e r parents, were not st u d i e d because of the small representation, of each. However, the two one-parent f a m i l i e s i n the sample reported no change i n t h e i r f u n c t i o n i n g i n the areas of work or school. No r e l a t i o n -ships were observed between the age of. the i d e n t i f i e d p a t i e n t and change through treatment.. Diagnosis of the i d e n t i f i e d p a t i e n t i n i t s r e l a t i o n to change was a l s o too d i f f i c u l t to analyze i n t h i s study because the sample was too small to represent the large number of diagnoses used. Of those diagnoses used more than once, the f o l l o w i n g observations were made: among f i v e diagnoses described as "adjustment r e a c t i o n to childhood" two f a m i l i e s reported p o s i t i v e change; among four diagnosed as "adjustment r e a c t i o n to -61 -adolescence" three reported p o s i t i v e change; one family i n two diagnosed as "schizoid personality" reported posi t i v e change; and one of two diagnosed as "psychoneurotic anxiety reaction" reported positive, change. Since only two of the families were rated by the therapists as remaining the "same" as to symptoms, families with change were compared to families with no change on the basis of "greatly improved" versus "moderately Improved" and "the same" (as I l l u s t r a t e d i n Table 16). The tendency f o r the therapists' Impressions to coincide with p o s i t i v e change i n these areas i s further evidenced by the observation that three of the f i v e i d e n t i f i e d patients whose symptom r e l i e f was rated as "greatly Improved" reported p o s i t i v e changes which they at t r i b u t e d as a r e s u l t of treatment, out of a t o t a l of four I d e n t i f i e d patients who did so (families H, L, P and 0). Table 16. Change i n Functioning at Work and School as  Related to Therapists' Impressions of  Symptom R e l i e f f o r I d e n t i f i e d Patient change rated as "greatly improved rated as "moderately improved" or "the same" reported change k 3 reported no change 1 10 Total 5 13 In analyzing s p e c i f i c sets of responses to the i n t e r -view schedule the authors found that most of the reports that pos i t i v e change had taken place occurred i n those items - 6 2 -d e a l i n g w i t h t a s k p e r f o r m a n c e . S e v e n f a m i l i e s ( f a m i l i e s , D, E, G, H, L, N, and P) h a d members who r e p o r t e d t h e s e changes i n t h e i r p e r f o r m a n c e a t work o r s c h o o l . P o u r i d e n t i f i e d p a t i e n t s ( f a m i l i e s D, E, L, a n d P ) , f o u r m o t h e r s , ( f a m i l i e s G, H, N, and P) t h r e e f a t h e r s , ( f a m i l i e s H, N, and P) and one s i b l i n g ( f a m i l y L) r e p o r t e d t o t h i s e f f e c t . O n l y two f a m i l y members ( f a m i l i e s H a n d K) r e p o r t e d change i n t h e a r e a o f t a s k s a t i s f a c t i o n . One f a t h e r and one i d e n t i f i e d p a t i e n t r e c a l l e d p o s i t i v e change i n e n j o y m e n t o f t h e i r t a s k s a t work and a t s c h o o l . T h r e e i d e n t i f i e d p a t i e n t s ( f a m i l i e s E, G, and 0) r e p o r t e d p o s i t i v e changes i n t h e i r r e l a t i o n s h i p s w i t h p e e r s a t s c h o o l . Among t h e i t e m s d e a l i n g w i t h r e l a t i o n s w i t h a u t h o r i t y , o n l y one f a m i l y member, an i d e n t i f i e d p a t i e n t , ( f a m i l y 0) r e p o r t e d p o s i t i v e c h a n g e . One n e e d n o t c o n c l u d e t h a t change n e c e s s a r i l y i s e f f e c t e d more i n t h e a r e a o f t a s k p e r f o r -mance. R a t h e r , t h e p r e c e e d i n g o b s e r v a t i o n s may m e r e l y r e f l e c t t h a t change i n t h i s a r e a i s more r e a d i l y p e r c e i v e d b e c a u s e t h e r e i s g r e a t e r o b j e c t i v i t y i n v o l v e d i n c r i t e r i a f o r p e r f o r m a n c e . T a s k s a t i s f a c t i o n , r e l a t i o n s w i t h a u t h o r i t y , and r e l a t i o n s w i t h p e e r s may be more s u b j e c t i v e l y p e r c e i v e d and h ence more s u b t l e t o e v a l u a t e o v e r a n i n t e r v a l o f one y e a r o r more. T e c h n i c a l l y , t h i s p o r t i o n o f t h e i n t e r v i e w s c h e d u l e c o u l d have b e e n somewhat r e d u c e d . Q u e s t i o n f o u r c o u l d have b e e n i n c o r p o r a t e d i n t o q u e s t i o n f i v e d e a l i n g w i t h t r a i n i n g o r e d u c a t i o n a l p r o g r a m s . The a u t h o r s f e l t t h a t t h e p r o b e , "Do you t h i n k t h e s a l a r y i s f a i r ? " , i n q u e s t i o n t h r e e , -63-should have been omitted because there appeared to be an interviewee set to respond to the negative, j o k i n g l y or otherwise. Upon f u r t h e r probing, the authors f r e q u e n t l y found the respondents would reverse t h e i r r e p l i e s . In c o n c l u s i o n , the data c o l l e c t e d i n t h i s s e c t i o n of . the i n t e r v i e w schedule may on s u p e r f i c i a l examination r e v e a l very s l i g h t p o s i t i v e changes which may be a t t r i b u t e d to treatment. However, when other f a c t o r s are taken i n t o c o n s i d e r a t i o n there i s evidence that treatment can e f f e c t p o s i t i v e change through time. F i r s t , i t has been noted by the authors that f a m i l y members d i d not rep o r t negative changes i n these areas. On one hand, one may conclude that f a m i l i e s i n general f a i l to acknowledge negative changes. On the other hand, one can speculate that treatment f o r the most p a r t , helped to s u s t a i n or enhance f u n c t i o n i n g i n these areas. Secondly, a n a l y s i s of change along i n these areas can be d e c e i v i n g i f the present f u n c t i o n i n g of the f a m i l y members i s not taken i n t o c o n s i d e r a t i o n . A trend i n change must have a p o i n t from which to change. Seven of the f a m i l i e s (A, B, C, F, K, I , R) r e p o r t i n g no change reported s a t i s f a c t i o n i n a l l f our areas at work and school. In other words, these f a m i l i e s i n d i c a t e d no problem e x i s t i n g i n these areas i n the f i r s t p l a c e . Among the remaining four f a m i l i e s c l a s s i f i e d as r e p o r t i n g no s i g n i f i c a n t changes (those without a t l e a s t one member r e p o r t i n g p o s i t i v e change i n one area which he a t t r i b u t e d to treatment, one member r e p o r t i n g p o s i t i v e change i n more than one area, or more than one member r e p o r t i n g change i n at l e a s t one -64-a r e a ) , d i s a t i s f a c t i o n was r e p o r t e d i n p r e s e n t f u n c t i o n i n g i n t h e s e a r e a s . The i d e n t i f i e d p a t i e n t i n f a m i l y J r e p o r t e d d i s a t i s f a c t i o n i n b o t h t a s k p e r f o r m a n c e and r e l a t i o n s w i t h p e e r s . The f a t h e r i n f a m i l y Q and t h e i d e n t i f i e d p a t i e n t i n f a m i l y . M r e p o r t e d n e g a t i v e l y on t a s k s a t i s f a c t i o n . I n f a m i l y D t h e i d e n t i f i e d p a t i e n t r e p o r t e d u n s a t i s f a c t o r y r e l a t i o n s w i t h p e e r s and a s i b l i n g r e p o r t e d u n s a t i s f a c t o r y t a s k p e r f o r m a n c e . I t i s i n t e r e s t i n g t o n o t e t h a t t h r e e o f t h e s e f o u r f a m i l i e s a t t e n d e d l e s s t h a n t h e m edian o f e i g h t number o f i n t e r v i e w s . F a m i l i e s J and Q a t t e n d e d o n l y one i n t e r v i e w , a n d f a m i l y M a t t e n d e d s i x i n t e r v i e w s . The r e m a i n i n g f a m i l y a t t e n d e d t w e l v e i n t e r v i e w s . O n l y two o f t h e f a m i l i e s r e p o r t i n g s i g n i f i c a n t p o s i t i v e change gave n e g a t i v e r e s p o n s e s t o p r e s e n t f u n c t i o n i n g I n t h e s e a r e a s . ( F a m i l i e s H and 0 ) . Hence, i t may be i n d i c a t e d t h a t f a m i l y g r o u p t h e r a p y i s e f f e c t i v e i n e n c h a n c i n g f u n c t i o n i n g i n e x t e r n a l f o r m a l t a s k - o r i e n t e d r e l a t i o n s when d i f f i c u l t i e s a r e m a n i f e s t e d i n t h o s e a r e a s . T h e r e a r e a l s o s u g g e s t i o n s t h a t f u n c t i o n -i n g c a n a l s o be i m p r o v e d when no d i f f i c u l t i e s a r e e x p e r i e n c e d i n t h e s e a r e a s . P o l a n s k y h y p o t h e s i z e s t h a t work i s a " l a s t b a s t i o n o f d e f e n s e " , 1 t h a t t h e work l i f e h o l d s o u t a g a i n s t e n c r o a c h i n g p a t h o l o g y , so t h a t when one b e g i n s t o l o s e h i s a b i l i t y t o work, t h i s i s t a k e n as a p a r t i c u l a r l y ominous s i g n . N e v e r t h e l e s s work i s i n t e r d e p e n d e n t w i t h one's o t h e r 1 P o l a n s k y , Norman A. "The P r o f e s s i o n a l I d e n t i t y i n S o c i a l Work," i n A l r e a d J . Kahn, I s s u e s i n A m e r i c a n S o c i a l Work, C o l u m b i a U n i v e r s i t y P r e s s , New Y o r k ; 1959 > P» 298. -65-spheres of l i v i n g . A n a l y s i s o f the d a t a i n t h i s s e c t i o n seems t o i n d i c a t e t h a t many f a m i l i e s e x h i b i t i n g p a t h o l o g y have not as y e t been i m p a i r e d i n m a t t e r s r e l a t e d t o t a s k p e rformance. Among those who do e v i d e n c e impairment a n a l y s i s of the d a t a s u g g e s t s t h a t f a m i l y group t h e r a p y does h e l p e f f e c t change, p a r t i c u l a r l y when a s u f f i c i e n t number of i n t e r v i e w s have been a t t e n d e d . One c o u l d s p e c u l a t e t h a t P o l a n s k y ' s a s s u m p t i o n may work i n r e v e r s e ; t h a t i s , the r e v e r s a l of p a t h o l o g i c a l p r o c e s s e s may be e v i d e n c e d i n work l a t e r . I n o t h e r words, p s y c h o l o g i c a l f u n c t i o n i n g and p r i m a r y r e l a t i o n s h i p s may f i r s t e v i d e n c e improvement t h r o u g h t r e a t m e n t , w h i l e f u n c t i o n i n g i n e x t e r n a l r e l a t i o n s w i l l show improvement l a t e r . Some f i n d i n g s i n t h i s s e c t i o n seem t o b e a r t h i s o u t s a t l e a s t t o the p o i n t o f e s t a b l i s h i n g a h y p o t h e s i s . Q u e s t i o n n a i r e A n a l y s i s - R o l e s The f i r s t q u e s t i o n asked f a m i l y members t o c o n s i d e r who makes the. major . d e c i s i o n s i n the h o u s e h o l d . I n one case the p a r e n t s ' response was n o t r e c o r d e d and i n t h r e e cases the c h i l d r e n ' s r e s p o n s e s were n o t r e c o r d e d . Responses were g e n e r a l l y mixed w i t h no r e a l l y c l e a r i n d i c a t i o n of t r e n d s . T h i s might be a t t r i b u t e d l a r g e l y t o i n t e r v i e w e r q u e s t i o n i n g t e c h n i q u e . F o r example, i n cases M, N, and K r e s p o n s e s were the same but t h i s c o u l d be m e r e l y c o i n c i d e n t a l . There was a v a r i a t i o n i n q u a l i f y i n g t h i s ques.tion but i t seemed t h a t where d e c i s i o n s had t o be made of a minor consequence^ no c o n s u l a t l o n s were made w h i l e major d e c i s i o n s were e i t h e r h a n d l e d s o l e l y by f a t h e r o r j o i n t l y by b o t h p a r e n t s bu t n e v e r -66-by mother a l o n e . R o l e s c e n t e r i n g a r o u n d d e c i s i o n - m a k i n g t e n d t o be c l e a r c u t . Of t h i r t y - f o u r r e s p o n d e n t s t o t h e q u e s t i o n r e l a t i n g d e c i s i o n - m a k i n g t o f a m i l y g r o u p t h e r a p y e l e v e n f e l t t h e r e had b e e n some improvement. One c o u p l e s a i d t h e y a l l o w e d t h e i r c h i l d r e n more i n d e p e n d e n c e ; a n o t h e r c o u p l e f e l t t h e r e was more " w o r k i n g t o g e t h e r as a f a m i l y team". The q u a l i f y i n g q u e s t i o n p e r h a p s d i d n o t s e e k what i t s e t o u t t o a s c e r t a i n , i n s t e a d t h e r e s p o n d e n t s seemed t o g i v e n a g e n e r a l i z e d answer r e l a t i n g t o t h e i r p e r c e i v e d changes s i n c e f a m i l y t h e r a p y and n o t s p e c i f i c a l l y t o d e c i s i o n - m a k i n g . Q u e s t i o n f o u r a s k e d f a m i l y members t h e change, i f any, i n p a r t i c i p a t i o n i n h o u s e h o l d d u t i e s s i n c e f a m i l y g r o u p t h e r a p y . E a c h members a c t i v i t y l e v e l was l o o k e d a t a n d c a t e g o r i z e d - b y l e s s a c t i v e , no change o r more a c t i v e . The f i n d i n g s c o i n c i d e f a i r l y c l o s e l y w i t h the r e s u l t s o f t h e h u s b a n d - w i f e q u e s t i o n n a i r e and so a r e n o t d i s c u s s e d i n t h i s s e c t i o n . 1 L o o k i n g a t t h e i d e n t i f i e d p a t i e n t and h i s s i b l i n g s a c t i v i t y i n t h e h o u s e h o l d r e v e a l e d t h a t n o t one member r e p o r t e d l e s s a c t i v i t y i n h o u s e h o l d d u t i e s , b u t a l l r e p o r t e d e i t h e r no change o r i n c r e a s e d a c t i v i t y . A no change i n amount o f a c t i v i t y r e s p o n s e must n o t be c o n s t r u e d as i n d i c a t -i n g i mprovement. I f one was i n a c t i v e o r a c t i v e i n h o u s e h o l d b e f o r e a n d a f t e r t r e a t m e n t t h e n t h i s i s p r e c i s e l y what was meant by t h e q u e s t i o n . The s i g n i f i c a n t f a c t o r h e r e was t h a t n o t one r e s p o n d e n t d i d l e s s t h a n b e f o r e t h e r a p y . We x F o r a d i s c u s s i o n o f t h i s see t h e s e c t i o n e n t i t l e d " R e l i a b i l i t y s t u d y o f H u s b a n d - w i f e T a s k S h a r i n g " and " R e l i a b i l i t y S t u d y : Husband's p a r t i c i p a t i o n i n d e x " . -6?-t h o u g h t i t w o u l d be r e l e v a n t t o examine t h e I d e n t i f i e d P a t i e n t ' s ( I . P . ) r e s p o n s e s t o t h i s q u e s t i o n . T h e r e a p p e a r s t o be no r e a l l y c l e a r r e l a t i o n s h i p b e t w e e n number o f i n t e r v i e w s and a c t i v i t y i n h o u s e h o l d d u t i e s . I t m i g h t be s a i d t h a t a l t h o u g h t h e r e i s no l e s s p a r t i c i p a t i o n by t h e I . P . two t h i r d s o f r e s p o n d e n t s showed no change w h i l e o n e - t h i r d o r s i x had a n i n c r e a s e i n a c t i v i t y . I n o t h e r words f o r some i n d i v i d u a l s more i n t e r v i e w s meant more p a r t i c i p a t i o n . T a b l e 17. Change i n H o u s e h o l d H e l p i n g A c t i v i t y  r e l a t e d t o Number o f I n t e r v i e w s N=18 3 o r l e s s I n t e r v . k o r more I n t e r v . No Change 3 .9 More A c t i v e 1 5 k Ik Once a g a i n t h e r e i s no a p p a r e n t r e l a t i o n s h i p between change i n h o u s e h o l d p a r t i c i p a t i o n a c t i v i t y and class member-s h i p . T h e r e i s however, some i n d i c a t i o n t h a t low class membership m i g h t have b e e n a f a c t o r i n f o u r of t h o s e r e s p o n d e n t s f r o m t h a t c l a s s . P e r h a p s , f i r m l y e s t a b l i s h e d p a t t e r n s a r e h a r d t o b r e a k e v e n w i t h t h e r a p y , , or i t is now more a c c e p t a b l e f o r c h i l d r e n t o p a r t i c i p a t e in areas where t h e r e i s t r a d i t i o n a l l y s t r o n g f e e l i n g s a b o u t h o u s e h o l d task s e g r e g a t i o n . F i n d i n g s f r o m t h i s t a b l e ( T a b l e , 1 9 ) a t f i r s t s u g g e s t -68-Table 18. Change In Household Helping  A c t i v i t y Related to Class N=18 Low Class High Class No Change More .Active 18 a s l i g h t increase i n the amount of household a c t i v i t y by I.P. where the therapists reported a change i n the family following therapy. While there may have been no actual change i n p a r t i c i p a t i o n by the I.E. his attitudes and feelings about i t may have changed. Of the nine who reported no change i n a c t i v i t y but who were supposed to have shown some gain we did not ascertain how many of this group was already active or in a c t i v e . Had this been done then this table might be more s i g n i f i c a n t . Table 1 9 . Change i n Household Helping A c t i v i t y N= 18 No Change Some Change No Change 3 9 More Active 1 5 4 14 18 When we compare a c t i v i t y with family type i t becomes apparent that constricted families are perhaps the least susceptible to change. This i s a r e p l i c a t i o n of the same figure i n Table 21. If we define one who i s more active as -69-h a v i n g c h a n g e d p o s i t i v e l y t h e n l e a d e r l e s s and d i s c o n n e c t e d f a m i l i e s a r e most l i k e l y t o change i n t h i s s p h e r e . T a b l e 20. Change i n H o u s e h o l d H e l p i n g A c t i v i t y  a s R e l a t e d t o F a m i l y Type N=l8 L e a d e r . C o n s t r i c t . C h a o t i c D i s c o n n e c t . D i e t a t . No Change 3 3 2 2 2 More A c t i v e 2 0 1 2 1 5 3 3 4 3' The r e s u l t s o f q u e s t i o n number f i v e a r e l i s t e d i n T a b l e 21. T h i s q u e s t i o n was a i m e d a t p a r e n t s a l t e r e d e x p e c t a t i o n s o f t h e i r c h i l d r e n and t h e c h i l d r e n ' s a l t e r e d e x p e c t a t i o n s o f t h e i r p a r e n t s . I t w o u l d a p p e a r t h a t p a r e n t s h a v e c h a n g e d t h e i r e x p e c t a t i o n s o f c h i l d r e n f a r g r e a t e r t h a n t h e l a t t e r s e x p e c t a t i o n s o f t h e p a r e n t s . E x a m i n i n g t h e p a r e n t ' s r e p l i e s , f a t h e r s a l t e r e d t h e i r e x p e c t a t i o n s i n e l e v e n o u t o f s i x t e e n c a s e s ( 6 9 $ ) s w h i l e f o r m o t h e r s i t was e i g h t o u t o f e i g h t e e n (44$). F o r I.P. o n l y two o u t o f e i g h t e e n (11$). a l t e r e d e x p e c t a t i o n s w hereas none o f t h e n i n e t e e n s i b l i n g s r e s p o n d i n g t o t h i s q u e s t i o n a l t e r e d t h e i r e x p e c t a t i o n s o f t h e i r p a r e n t s . The s i x t h q u e s t i o n was d i r e c t e d a t t h e c h i l d r e n t o f i n d o u t t h e i r a c c e p t a n c e o f p a r e n t a l judgment on most d e c i s i o n s . F o u r o u t o f e i g h t e e n I.B's r e p o r t e d t h a t t h e y do n o t a c c e p t t h e i r p a r e n t ' s j u d g m e n t s . Two o f t h e s e c a s e s were D and F, one p a r e n t f a m i l i e s . Of t w e n t y - t w o -70-s i b l i n g r e p l i e s only one did not accept his parent's judgments. Perhaps this finding might be explained by the fact that accepting parental decisions i s a c u l t u r a l role expectation. 1 While patients and t h e i r s i b l i n g s accept t h e i r parent's judgments i n 87$ of a l l responses this must be q u a l i f i e d . Several of the respondents f e l t that they had greater understanding of t h e i r parents since family group therapy and accept t h e i r duties i n a more responsible manner. Those cases where this applied were families B, E, H, I, L s and P. One I„P. said that the greatest Improve-ments i n t h i s area occurred during and Immediately a f t e r treatment but that since then things had returned to t h e i r former state. The trend here was not necessarily greater acceptance of parental decisions but greater understanding of the rationale behind the decisions. Table 21 . ..Respondents Change i n Household af i i l p l n g A^lv:;ity.-iJavs. Related, to .. Members' Role Performance Same Expectation Altered Expectation N=l6 Father 15 ' 11-N=18 Mother 10 8 N=18 I. P. 16 2 N=19 Siblings 19 0 50 21 Question seven served as a q u a l i f i e r to the previous one by way of asking whether other family members (parents 1 Williams, J r . op. c i t . -71-a n d s i b l i n g s ) l i s t e n e d t o t h e i r i d e a s . We m i g h t have worded t h i s q u e s t i o n , "Are r o l e e x p e c t a t i o n s r e c i p r o c a l i n y o u r f a m i l y ? " . Of t h e I.P. r e s p o n s e s 8 3 $ f e l t " l i s t e n e d t o 1 by o t h e r f a m i l y members. T h i s compares w e l l w i t h t h e p r e v i o u s f i g u r e o f 8 7 $ who a c c e p t e d p a r e n t a l judgment. A s i m i l a r f i g u r e o f 8 0 $ o f s i b l i n g r e s p o n d e n t s f e l t u n d e r s t o o d . I n d i s c u s s i n g t h i s q u e s t i o n s e v e n r e s p o n d e n t s spoke o f a v e r y d e f i n i t e change i n h a v i n g t h e i r t h o u g h t s h e a r d . O n l y two o f t h e i.P.'.s r e p o r t e d a change due i n ' t h e i r m ind' t o 1 2 t h e r a p y , w h i l e s e v e n s i b l i n g s r e p o r t e d c h a n g es due as a r e s u l t o f t h i s e x p e r i e n c e . The e i g h t h q u e s t i o n a s k e d p a r e n t s and c h i l d r e n I f t h e i r p l a c e i n t h e f a m i l y h a d b e e n a l t e r e d s i n c e a t t e n d i n g t h e c l i n i c . I t was hoped t h i s w o u l d answer t h e q u e s t i o n "Has y o u r r o l e i n t h e f a m i l y c h a n g e s s i n c e F a m i l y G roup T h e r a p y ? " b u t t h e r e was no v e r i f i c a t i o n t h a t t h i s was t h e a n swer r e c e i v e d . F o r t h e r e s p o n d e n t s t o t h i s q u e s t i o n ( T a b l e 22) i f we f i r s t l o o k a t t h e t o t a l number of change v e r s u s no change we f i n d a l m o s t a p e r f e c t c h a n c e s p l i t . F o r m o t h e r s an d I . P . ' s t h i s I s s i n f a c t . , t h e c a s e . The g r e a t e s t change i s I n d i c a t e d by t h e f a t h e r s where t e n o f s i x t e e n ( 6 2 $ ) r e p o r t e d Improvements i n f e e l i n g s o f t h e i r p l a c e I n t h e f a m i l y . T h i s f i g u r e compares v e r y c l o s e l y w i t h t h a t of f a t h e r ' s f e l t a l t e r a t i o n i n r o l e p e r f o r m a n c e o f 69$. By t h e s e two f i g u r e s i t m i g h t be I n d i c a t e d t h a t f a t h e r s m i g h t •^Cases C and E . 2 C a s e s B s G, H s and 0 . -72-tend to benefit the most often from family group treatment, Table 22. Respondent's Feelings of Change about N=68 No Change Some Change Father 6 1 0 Mother ? 9 I.P. 9 9 Slbs. 8 8 3 2 3 6 6 8 Table 2 3 would seem to suggest that with the Increase i n number of Interviews the father's place i n the family tends to change p o s i t i v e l y . Conversely, with fewer i n t e r -views less change can be expected. The mean number of interviews for fathers f e e l i n g a change i n t h e i r place i n the family who had four or more interviews was 1 2 . 3 while for those fathers who reported no change i n four or more i n t e r -views the mean number* of sessions was 8 . 2 . I f we l o o k at th i s according t o class we see the relationships as outlined i n Table 24. Table 2 3 . Number of Interviews Related to Fathers Change N = l 6 3 or Less 4 or More No Change 2 4 Some Change 1 • 9 3 1 3 1 6 There Is no difference i n high class fathers with the -73-r e s u l t s f a l l i n g on e x a c t l y c h a n c e . However, t h e r e I s a s u b s t a n t i a l d i f f e r e n c e i n low c l a s s f a t h e r s w i t h s i x o u t o f e i g h t (75$) r e p o r t i n g a change i n t h e i r f e e l i n g s a b o u t t h e i r p l a c e i n t h e f a m i l y s i n c e a t t e n d i n g f a m i l y g r o u p t h e r a p y . T a b l e 24. F a t h e r ' s Change i n h i s F e e l i n g s a b o u t h i s  P l a c e i n t h e F a m i l y R e l a t e d t o C l a s s N=l6 Low C l a s s H i g h C l a s s No Change 2 4 Some Change 6 8 8 16 I n t h e f i n a l s e c t i o n o f t h i s p a r t o f t h e q u e s t i o n n a i r e f a m i l y members were a s k e d t o g i v e examples where t h e y f e l t t h e i r p l a c e i n t h e f a m i l y had been s p e c i f i c a l l y a l t e r e d . E i g h t o f t h e f a t h e r s r e p o r t e d a g r e a t l y e n c h a n c e d s e l f -c o n c e p t i n t h e r o l e o f f a t h e r . S i x m o t h e r s r e p o r t e d a g a i n i n s e l f - c o n f i d e n c e i n t h e i r r o l e s . S i x o f t h e I . P . ' s r e p o r t e d f e e l i n g s o f more b e l o n g i n g t o t h e f a m i l y a n d f e l t more i m p o r t a n t . F i v e o f t h e s i b l i n g s r e p o r t e d t h e y f e l t b e t t e r a b o u t t h e i r p l a c e i n t h e f a m i l y . I n c a s e P a s i b l i n g i s q u o t e d : " I f e e l t h e r e ' s a p l a c e f o r me i n t h e f a m i l y " , a n d i n c a s e G: " I f i g u r e I'm one o f them now". T h e r e a r e some i n d i c a t i o n s h e r e t h a t improvement by one member o f t h e f a m i l y i n h i s f e e l i n g s a b o u t h i s p l a c e i n t h e f a m i l y w i l l have s i m i l a r e f f e c t s on o t h e r s . A t t i t u d e s t o S o c i a l A g e n c i e s , I n answer t o q u e s t i o n one c o n c e r n i n g t h e u s e o f s o c i a l a g e n c i e s a n d t h e changes i n a t t i t u d e f o l l o w i n g t h e r a p y a l l b u t one f a m i l y and p a r t o f a n o t h e r f e l t t h a t f a m i l y g r o u p t h e r a p y i t s e l f was n o t t h e d e t e r m i n i n g f a c t o r . However-, e i g h t f a m i l i e s f e l t t h a t t h e i r f e e l i n g s had c h a n g e d f o l l o w i n g t h e r a p y . We w o u l d c o n j e c t u r e h e r e t h e n t h a t i t was as a r e s u l t o f a g e n c y c o n t a c t and n o t f a m i l y g r o u p t h e r a p y i t s e l f t h a t t h e s e a t t i t u d e c h a n g es o c c u r r e d . F i v e o f t h e eight-f a t h e r s . , f e l t t h a t t h e i r a t t i t u d e s h a d i m p r o v e d and i n f o u r c a s e s t h e r e m a i n d e r o f t h e f a m i l y s u p p o r t e d h i s f e e l i n g . However, i n one c a s e t h e i d e n t i f i e d p a t i e n t f e l t t h a t he d i d n o t l i k e a g e n c y c o n t a c t as h i s s c h o o l mates s c o r n e d him. T h r e e o f t h e e i g h t f a t h e r s f e l t t h a t t h e i r e x p e r i e n c e a t t h e M e n t a l H e a l t h C e n t r e had a d e t r i m e n t a l a f f e c t on a g e n c y a t t i t u d e s . I n a l l t h r e e c a s e s t h e r e s t o f t h e f a m i l y a g r e e d i n t o t a l . F o u r f a t h e r s and m o t h e r s who h a d o r i g i n a l l y h e l d n e g a t i v e a t t i t u d e s d i d n o t m o d i f y t h e i r o p i n i o n s a f t e r c o n t a c t w i t h t h e M e n t a l H e a l t h C e n t r e . However, i n only two c a s e s were t h e y s u p p o r t e d t o t a l l y by t h e i r f a m i l i e s . I n t h e o t h e r two c a s e s d e s p i t e t h e f a t h e r ' s n e g a t i v e a t t i t u d e s t h e L P s . , b o t h f e l t t h a t t h e i r a t t i t u d e t o w a r d a g e n c i e s had i m p r o v e d . T h i s m i g h t p o s s i b l y be b e c a u s e t h e v e r y f o r m o f f a m i l y g r o u p t h e r a p y r e m o v e s t h e onus f r o m t h e I.P, and p l a c e s i t on t h e f a m i l y , t h u s t h e f a t h e r and m o t h e r s d i s c o m f o r t . F i v e f a t h e r s and m o thers f e l t t h a t t h e i r o r i g i n a l l y p o s i t i v e a t t i t u d e s t o w a r d a g e n c i e s had n o t b e e n a l t e r e d by t h e i r e x p e r i e n c e a t t h e M e n t a l -75-H e a l t h C e n t r e . I n a l l o f t h e s e c a s e s t h e f a m i l y a g r e e d c o m p l e t e l y . I n t h e f i n a l a n a l y s i s i t a p p e a r s t h a t f i v e f a m i l i e s were p o s i t i v e l y I n f l u e n c e d and f i v e r e m a i n e d p o s i t i v e l e a v i n g a t o t a l o f t e n r e t a i n i n g p o s i t i v e a t t i t u d e s a b o u t a g e n c i e s a f t e r f a m i l y g r o u p t h e r a p y a t t h e M e n t a l H e a l t h C e n t r e . The r e m a i n i n g e i g h t f a m i l i e s were e s s e n t i a l l y n e g a t i v e . , t h r e e b e c o m i n g n e g a t i v e a f t e r t h e i r e x p e r i e n c e a t t h e M e n t a l H e a l t h C e n t r e . T h e r e were o n l y t h r e e c a s e s o f change i n r e l i g i o u s p a r t i c i p a t i o n o r a t t i t u d e s f o l l o w i n g f a m i l y g r o u p therapy„ One m other (P") as a r e s u l t o f t h e r a p y m o d i f i e d h e r c h u r c h i n t e r e s t s a n d d e v o t e d more a t t e n t i o n t o h e r f a m i l y . One i d e n t i f i e d p a t i e n t (If) f e l t t h a t he was a b l e t o a c c e p t t h e t e a c h i n g s o f t h e c h u r c h more r e a d i l y . One I d e n t i f i e d p a t i e n t (E) as a r e s u l t o f t h e r a p y became more o u t g o i n g and s u r e o f h e r s e l f a n d b e g a n p a r t i c i p a t i n g i n more c h u r c h g r o u p s w h e r e a s b e f o r e she was o n l y a n o m i n a l a t tender,. One c h i l d i n an o t h e r w i s e u n c h a n g e d f a m i l y ( 0 ) be gan vO a t t e n d Sunday S c h o o l b u t he f e l t t h a t t h i s had n o t h i n g t o do w i t h f a m i l y g r o u p t h e r a p y b u t was o n l y b e c a u s e he had t o go t o c o n f i r m a t i o n c l a s s e s . O n l y i n one c a s e (P) was r e l i g i o u s a c t i v i t y a c t u a l l y m o d i f i e d and u s e d I n a more p r o d u c t i v e way s i n c e f a m i l y g r o u p t h e r a p y . I n answer t o q u e s t i o n t h r e e w h i c h i s d e s i g n e d t o e v a l u a t e any change i n t h e f a m i l y ' c h a n g e s i n u s e s o f commun-i t y r e s o u r c e s there, were v e r y few d i f f e r e n c e s r e c o r d e d . O n l y one f a t h e r f e l t t h a t f a m i l y g r o u p t h e r a p y h a d -76-contributed to a change i n h i s l e v e l of community p a r t i c i p a -t i o n . He became active i n men's instead of boy's sports (E). Three mothers changed. One of them was the wife of the previously mentioned man. She became more sure of the value of her own feelings and interests and joined an a r t group. The two other women reduced t h e i r club a c t i v i t y to spend more time with t h e i r f a m i l i e s . There were more changes among the I.P. Four i d e n t i f i e d patients a f t e r family group therapy joined groups that they had not been interested i n p r i o r to family group therapy. One of these i d e n t i f i e d patients was i n the same family as the above mentioned changed mother and father. This i s the only family (E) where the change has occurred i n more than one member. Among other children i n the families there were no changes they could r e c a l l before or a f t e r family group therapy. In summation then out of the eighteen families there was one family (E) where three members changed and there were six families where one member changed i n u s e o f community resources. There are only two families whose change i n r e l i g i o n and community resources seemed to be connected with each other. One family e s p e c i a l l y the mother when giving up time f o r r e l i g i o n also gave up a u x i l i a r y groups and spent more time with her family. The other family e s p e c i a l l y the I.P. became more interested i n outside a c t i v i t i e s a n d joined c h u r c h groups. There seemed to be no constancy i n these two families as regards agency at t i t u d e s . The family who became less active has a p o s i t i v e experience and the more -77-active ones described t h e i r experience as d e f i n i t e l y negative. In t h i s section agency attitudes seems to be the area where most families experienced at l e a s t a reaction as a r e s u l t of family group therapy. Where i n the other two areas, Religion and Community resources, aside from two families l i t t l e change occurred. None of this change was connected i n the families mind with family group therapy with two exceptions, the; families above mentioned. As the section on agency attitudes seemed to be the area where most change occurred we used this section for tables i n comparison with other v a r i a b l e s . The following are tables showing the r e l a t i o n of attitudes to the number of interviews, the family type, the therapists impressions and to a l l other sections of the questionnaire. The conclusions to be drawn from each table follow the table immediately > ., Table 25. Attitudes toward the agency i n families with  three or less interviews as compared with  those with four or more: No. of interviews p o s i t i v e negative 3 or less 2 - (20$) 7 - (87$) k or more 8 - (80$) 1 - (13$) . 10 . There would appear to be some rel a t i o n s h i p between the attitudes retained by the families and the number of i n t e r -views. I t could be suggested that those with more positive attitudes stayed f o r more interviews or that more - 7 8 -Interviews tended to make families attitudes more p o s i t i v e 0 Table 2 6 . The soolo-economlc p o s i t i o n of families  with p o s i t i v e attitudes as compared  with those with negative a t t i t u d e s : Hollingshead scale (See Key) Socio-Economic Positive Negative Total High 7 ,70%) )• 3 (38$) ) 10 Low 3 (30$) 5 ( 6 2 $ ) . 8 Total 10 8 .... 18 It would appear that high economic status i s related to p o s i t i v e agency attitudes.. ;. Perhaps as these people of high socio-economic status are functioning well i n at least some areas i t i s not as threatening for them to ask f o r and receive help i n other-areas. Also as they are more a r t i c u l a t e the verbal form c f therapy can be u t i l i z e d w e l l . Their areas of dysfunction are more c l e a r l y defined. Table 2 7 . The therapists ratings of families with  po s i t i v e attitudes as compared with  those with negative a t t i t u d e s : Therapists Positive Negative Total High 7 ( 7 0 $ ) " 7 ( 8 7 $ ) 14 Low 3 ( 3 0 $ ) 1 ( 1 3 $ ) 4 Total 1 0 8 1 8 There would not appear to be any connection between the therapist's Impression of success of treatment and the family's attitudes toward the agency. -79-Table 28. Improvement In other areas as r e l a t e d to agency  a t t i t u d e s . Two or more areas of noted change  w i l l c o n s t i t u t e improvement f o r these  purposes. improvement l e v e l p o s i t i v e negative t o t a l no improvement 3. (30$) 5 (62$) 8 at l e a s t some improvement • 7 (70$) 3 (38$) 10 T o t a l 10 8 18 The f a m i l i e s p o s i t i v e a t t i t u d e s would appear to be r e l a t e d to t h e i r p e r c e p t i o n of change. The percentage of those remaining p o s i t i v e when they perceived change i s much g r e a t e r than those remaining p o s i t i v e when they perceived no change. E x t e r n a l Family R e l a t i o n s h i p s and  use of Community Resources. Before we describe our f i n d i n g s i n t h i s p a r t i c u l a r s e c t i o n , we wish to e x p l a i n that i n our t o t a l sample f a m i l i e s of eighteen, two f a m i l i e s , designated w i t h the l e t t e r s D and F, are one parent f a m i l i e s , w i t h the mother being the only-parent. Therefore In those areas where we are d e s c r i b i n g data, i n reference to the f a t h e r s , N w i l l equal s i x t e e n , and where we are d e s c r i b i n g data concerning the mothers, N w i l l equal eighteen. The only s e c t i o n where there Is a d e v i a t i o n of t h i s i s i n our f i r s t p a r t of the questions, where only f i f t e e n f a m i l i e s , out of the t o t a l of eighteen, have r e l a t i v e s i n and around the Vancouver and Lower Mainland area. 80-In the f i f t e e n families that have r e l a t i v e s in this area, there were f i v e families that had d a i l y contact with each other; f i v e families that had weekly contact; four families that had monthly contact and only one family had contact with t h e i r r e l a t i v e s on a yearly basis. The most common way of e f f e c t i n g contact with r e l a t i v e s was by telephone and r e c i p r o c a l v i s i t a t i o n s i n one another's homes. I.t i s i n t e r e s t i n g to note that i n the v i s i t a t i o n patterns, i n these f i f t e e n f a m i l i e s , the frequency of v i s i t i n g the mothers' r e l a t i v e s seemed to predominate, as we found that seven of the f i f t e e n families preferred the mothers' side of the family, and of the four families primarily v i s i t e d the fathers - side of the family,, the remaining four families v i s i t e d either the mothers' or fathers' side of the family on an equal basis. In r e f e r -ence to the change i n the pattern of v i s i t i n g or contact with r e l a t i v e s subsequent to being treated in family group therapy sessions, twelve families reported that there were no changes i n t h e i r contact or v i s i t i n g patterns and three families reported they had experienced some change a f t e r having been treated i n family group therapy sessions. In reference to the v i s i t a t i o n patterns and contact with family friends, i n those families where there was a father present (N equals sixteen), we found that f i v e families predominately v i s i t e d the fathers' side, six of the f a m i l i e s ' preferred the mothers' friends and seven families f e l t that they v i s i t e d t h e i r family friends with -81-no d i s t i n c t i o n or preference to either the fath e r s 5 or mothers' friends. As for the amount of change In v i s i t -ing or contact i n t h i s area, fourteen families reported no change and four families reported some change subsequent to family group therapy. In the area of the fam i l i e s ' use of community resources, sixteen f a m i l i e s , where there were two parents in the family system,, seven of the fathers reported that they used community resources and nine reported they did not. The mothers (N equals eighteen), twelve reported they used community resources and six mothers did not. As for the i d e n t i f i e d patients (N equals eighteen), f i f t e e n I.P.'.s.' used community resources and three I.P.'.s did not. The frequency i n the use or non-use of the community resources breaks down to t h i s ; of the fathers, s i x used them often,, three fathers used them seldom and seven fathers never used community resources. The mothers, on the other hand,, (1\T equals eighteen), eight mothers used them often, four mothers used them seldom', and, six mothers never frequent their community resources. As for the I.P.'.s,, ten used them often^, s i x used them seldom and two I.P.'s. never used community resources at a l l . In reference to changes i n the frequency of use of community resources, fourteen fathers reported that there was no change and two fathers indicated that there was some change since being i n family group therapy sessions. Our findings concerning the change i n the use of community resources by the mothers (N equals eighteen), sixteen -82-mothers reported no change and only two reported any change since family group therapy. This figure corresponded exactly with that of the I.E.'.s findings, i n reference to the amount of change subsequent to family group therapy sessions. . In the area of the desire to associate with people, whether i t be with extended family or family f r i e n d s , s i x -teen of the fathers reported p o s i t i v e indications that they wanted to j o i n other people i n various a c t i v i t i e s . More-over, sixteen of the mothers answered i n the affirmative, however, two of the mothers reported that they did not wish to have any contact with t h e i r r e l a t i v e s or friends, people external to the nuclear family. It Is very i n t e r e s t -ing to note that of the eighteen I.E.'.s sixteen answered i n the affirmative and only two did not express any desire to have any contact with r e l a t i v e s or friends. This may be s i g n i f i c a n t , i n that the only families that did not wish to have any contact with r e l a t i v e s or friends were the two one parent fa m i l i e s , designated with the l e t t e r s D and P, i n our study. This may have further significance i n that i n these two fa m i l i e s , there may be a d e f i n i t e trend of a symbiotic r e l a t i o n s h i p between the mother and the I.P.,. thus showing a pattern of Isolation from extended family relationships and very minute contact with people outside the nuclear family. This w i l l be discussed i n f u l l e r d e t a i l l a t e r i n our section. In the amount of contact with r e l a t i v e s and friends, f i f t e e n fathers reported no change i n t h e i r pattern of v i s i t i n g and contact and only one of the fathers reported - 8 3 -any change In t h i s area. Of the eighteen mothers questioned, sixteen reported no change i n t h i s area and only two had any change since family group therapy. A close r e l a t i o n s h i p to t h i s lsy- the I.P. ' s findings, i n that they reported fourteen had experienced no change and four experienced some change due to family group therapy. , •• In our study, we are interested to,learn what changes had come about by the use of family group therapy, and i t i s important to note the following information. When we asked a l l eighteen families whether any changes i n (a) v i s i t i n g patterns to family r e l a t i v e s and friends; (b) the use of informal community resources; and (c) whether there was a change i n the frequency i n a l l three areas, was i t more, the same, or l e s s , a preponderant number of fa m i l i e s , t h irteen out of the eighteen, reported that there were no changes brought about as a r e s u l t of family group therapy and only f i v e families reported d e f i n i t e change i n t h i s area due to t h e i r experience In family group therapy sessions. The general trend of change i n the external family relationships and the whole family's u t i l i z a t i o n of informal community resources seems to be of no great s i g n i f i c a n c e , that i s d i r e c t l y a t t r i b u t a b l e to family group therapy. Of the f i v e f amilies that experienced change due to family group therapy, three of the f a m i l i e s ' "type" were described as being a "disconnected family" which i s a family where, -84-. . there i s a lack of family l o y a l t y and pride and one member's hurt i s often not f e l t by another. Each family member goes his own way."1 The other two fami l i e s , were diagnosed as being a leader-less family and these are the families where "there i s no i power of decision and the children run the family. "*• The family group therapy team states that the diagnostic family types "have been arrived at by the joint decision of the team as being the most useful descriptive terms f o r the families we have seen,"-^ i n family group sessions. The significance we attach to t h i s sectional analysis i s that regardless of the diagnostic type of the family, family group therapy, as an agent of change, In the areas of external family relationships and use of informal community resources, has l i t t l e effectiveness. The small change indicated i n t h i s area may be due to the lack of d i s s a t i s f a c t i o n r e l a t i v e to this area rather than a t t r i b u -table to ineffectiveness of treatment. The amount of d i s s a t i s f a c t i o n , i n the area of kinship r e l a t i o n s h i p i s small therefore l i t t l e change was sought. This suggests, then that external family relationships and use of community resources i s not an area of major or frequent change, but apparently i t i s not an area of frequent serious problems. I t w i l l be borne out i n the analysis of other areas of the family's functioning, f o r example communications 1 . , Family Types. Unpublished Material on Diagnostic Family Types, BMHC, Burnaby, B.C. See Appendix I I . Loc. c i t . -^Loc. c i t . and r o l e s , t h a t t h e amount o f change i s more s i g n i f i c a n t . T h i s may be due t o t h e f a c t t h a t e x t e r n a l f a m i l y r e l a t i o n -s h i p s and t h e u s e o f community r e s o u r c e s a r e n o t a s i m p o r t a n t a r e a s f o r n e e d e d change a s i n t h e o t h e r a r e a s m e n t i o n e d , s u c h as c o m m u n i c a t i o n p a t t e r n s and r o l e p e r f o r m -a n c e s and e x p e c t a t i o n s . . A n o t h e r s i g n i f i c a n t f i n d i n g i n t h i s p a r t i c u l a r s e c t i o n a l a n a l y s i s i s t h a t i n t h e two one p a r e n t f a m i l i e s ( f a m i l i e s D and F ) t h e r e was a d e f i n i t e t r e n d t o w a r d s s o c i a l i s o l a t i o n w i t h p e o p l e e x t e r n a l t o t h e i r own c l o s e f a m i l y s y s t e m . I n t h e s e two f a m i l i e s t h e m o t h e r s and t h e I.P.'s d i d n o t v o i c e any d e s i r e o r g i v e any i n d i c a t i o n o f t h e i r w a n t i n g t o j o i n o t h e r p e o p l e i n d o i n g t h i n g s , v i s i t i n g r e l a t i v e s o r f r i e n d s o r u s i n g community r e s o u r c e s . They seem t o p r e f e r t h e r e l a t i o n s h i p s w i t h i n t h e i r own c l o s e d n u c l e a r f a m i l y ( w i t h t h e a b s e n c e o f t h e f a t h e r ) . We c a n o n l y p o s t u l a t e t h a t i f t h e s e two f a m i l i e s ' 1 i s o l a t i o n f r o m t h e l a r g e r community were so o u t s t a n d i n g , t o p r e c l u d e a l l o t h e r s o c i a l r e l a t i o n s h i p s , e x t e r n a l t o t h e i r own p a r t i c u l a r -f a m i l y , t h e n we c a n f u r t h e r assume t h a t t h e r e may be a s y m b i o t i c r e l a t i o n s h i p between t h e mother and t h e I.P., i n t h e s e two f a m i l i e s . One o f t h e t h e r a p i s t s f o u n d t h a t t h e one p a r e n t f a m i l i e s a r e t h e most d i f f i c u l t t o t r e a t , i n t e r m s o f f a m i l y g r o u p t h e r a p y . "One p a r e n t f a m i l i e s t a k e l o n g e r ( t o t r e a t ) and n o t as much c a n be a c c o m p l i s h e d and b e c a u s e o f t h e g o a l s have t o be l i m i t e d . " - 1 - In o u r f i n d i n g s , , T h e r a p i s t ' s I m p r e s s i o n s , U n p u b l i s h e d q u e s t i o n n a i r e u s e d f o r t h i s t h e s i s . t h e one p a r e n t f a m i l i e s e x p e r i e n c e d l i t t l e - b e n e f i t f r o m f a m i l y g r o u p t h e r a p y and t h e c h a n g e s , i f any., were p r i m a r i l y n e g a -t i v e , , i n t h a t t h e i r i s o l a t i o n o f e x t e r n a l f a m i l y r e l a t i o n s h i p s seemed t o be re-enforced„ r a t h e r t h a n m o d i f i e d . I t wo u l d seem t h e r e f o r e , t h a t one p a r e n t f a m i l i e s n e e d g r e a t e r a t t e n t i o n on a n i n d i v i d u a l b a s i s , , r a t h e r t h a n b e i n g t r e a t e d i n f a m i l y g r o u p t h e r a p y s e s s i o n s . However,, f u r t h e r r e s e a r c h i s n e e d ed i n t h i s p a r t i c u l a r a r e a t o j u s t i f y t h i s s t a n d . Communicat1on R e f e r r a l t o A p p e n d i x I I w i l l i n d i c a t e t h e q u e s t i o n s a s k e d o u r sample s i z e o f e i g h t e e n f a m i l i e s i n a r e a o f communication„ We ' A ' I I I f i r s t examine t h i s l a r g e a r e a o f u n d e r s t a n d i n g i n w h i c h we have i n c l u d e d b o t h i n t e l l e c t u a l u n d e r s t a n d i n g and t h e u n d e r s t a n d i n g o f t h e f e e l i n g s o f t h e f a m i l y members. As Thomas H o r a s u c c i n c t l y p u t i t s To u n d e r s t a n d h i m s e l f . , man n e e d s t o be u n d e r s t o o d by smother,. To be u n d e r s t o o d by another,, he needs t o u n d e r s t a n d t h e o t h e r . 1 T h i s u n d e r s t a n d i n g p r e s u p p o s e s c o m m u n i c a t i o n . U n d e r t h i s area., we have g r o u p e d q u e s t i o n s 1,, 2 , 6 , 8,. 9 , and 11 o f o u r q u e s t i o n n a i r e . The s e c o n d a r e a we w i l l be l o o k i n g a t i s t h i s m a t t e r o f f a m i l y d i s c u s s i o n s w h i c h w i l l i n c l u d e a n e x a m i n a t i o n o f t h e f r e q u e n c y w i t h w h i c h t h e d i s c u s s i o n s a r e c o n d u c t e d w i t h i n t h e f a m i l y . , t h e c o n t e n t o f t h e s e d i s -c u s s i o n s and l a s t l y , . , t h e i r outcome w i t h t h e f a m i l i e s i n v o l v e d . U nder t h i s a r e a , we have g r o u p e d q u e s t i o n s 3? 4,, 5 , 7 . , and 10 o f o u r Q u e s t i o n n a i r e . - 8 7 -Of o u r sample o f e i g h t e e n c a s e s , we f o u n d n i n e f a m i l i e s who r e p o r t e d some change i n t h e i r a b i l i t y t o u n d e r s t a n d what was b e i n g s a i d d u r i n g f a m i l y m e e t i n g s . S i n c e we have l e t t e r e d o u r c a s e s f r o m A t o R. t h e f a m i l i e s who r e p o r t e d change i n t h i s a r e a a r e s B,, C„ E . G„ I , L, N, 0, P. I n t h r e e o f t h e f a m i l i e s "0„ I., G", m o t h e r had d i f f i c u l t y i n u n d e r s t a n d i n g t h e r e s t o f t h e f a m i l y . However, g e n e r a l i m p r o v e d u n d e r s t a n d i n g was r e a c h e d t h r o u g h t h e u s e o f c l a r i f i c a t i o n , s p e a k i n g up t o make s e l v e s u n d e r s t o o d , o r by g e n e r a l l y v o i c i n g t h e i r o p i n i o n s more o f t e n . I t was i n t e r e s t i n g t o n o t e t h a t one o f t h e f a m i l i e s " B " h a d r e p o r t e d change i n t h i s a r e a , d e s c r i b e d a d r o p p i n g o f f and r e t u r n t o o l d p a t t e r n s . We a l s o n o t i c e d a t e n d e n c y f o r t h e I.P. t o make h i m s e l f u n d e r s t o o d by t h e f a m i l y a n d f o r t h e p a r e n t s t o show g r e a t e r u n d e r s t a n d i n g o f t h e I . P . B e f o r e we s t a r t t o make p o s t u l a t i o n s i n t h i s b r o a d a r e a o f u n d e r s t a n d i n g , l e t us l o o k i n more d e t a i l a t t h e a r e a o f c l a r i t y o f meanings in. what i s s a i d by f a m i l y members. We f o u n d t h a t n i n e f a m i l i e s n o t e d some change i n t h e i r a b i l i t y t o u n d e r s t a n d what f a m i l y members mean by what t h e y s a y , w i t h t h r e e o f t h e s e f a m i l i e s N, P, G, f e e l i n g t h a t f a m i l y g r o u p t h e r a p y was o n l y i n d i r e c t l y h e l p f u l t o them* We a l s o n o t e d t h a t t h e r e were t h r e e f a m i l i e s i n w h i c h t h e r e was i m p r o v e d u n d e r s t a n d i n g b e t w e e n h u s b a n d and w i f e . Of t h e s e ' n i n e f a m i l i e s who f e l t t h a t t h e r e had b e e n change i n t h i s a r e a , t h e r e were s e v e n c a s e s where a t l e a s t some o f t h e f a m i l y members f e l t t h a t t h e y d i d n o t a l w a y s u n d e r s t a n d what o t h e r f a m i l y members meant by what t h e y -88-sald. This i s our f i r s t i n d i c a t i o n of meta-communication, for i n these seven families some members f e l t that the words coming out of another member's mouth did not always match the look on his face. Although i t would appear that the meta-cbmmunicatlons did not always fit,"'* i t would appear that family members s t i l l f e l t that they noted change i n a number of d i f f e r e n t areas. There were many comments i n t h i s area with the most common one being an Increased e f f o r t i n the fami l i e s ' attempts to understand family members—this also Includes t h e i r attempts to understand and be understood by others. Another area of comments pointed out more recognition given to meanings and more seeking out of information for c l a r i f i c a t i o n . One could postulate from our findings i n this area that i t may not be important for the family fo always know what i t s members mean but rather they should be able to check out„ c l a r i f y , and question meanings where i t i s appropriate. I t would appear that family group therapy gives the family an opportunity to see this process i n operation through the observation of. and p a r t i c i p a t i o n w i t h t h e therapist i n a similar process—as described b y Dr. B e l l i n his description of the task for the t h e r a p i s t . 2 Looking now at the area of understanding feelings, we w i l l look at question six which deals with how family members usually show each other when they are happy and angry with each other. Here we are looking f o r family 1 S a t i r , op. c i t . . p. 79 2 B e l l , op. cit... pp. 44-47. - 8 9 -group therapy to ef f e c t some change In th e i r a b i l i t y to express f e e l i n g s . We found eight families who reported some change i n this area. As one might expect, i n the answering of thi s question, family members found t h i s to be a purely i n d i v i d u a l matter, largely depending on the si t u a t i o n and on whom they were happy and angry with. To get at t h i s area we asked four questions: Do you t e l l them d i r e c t l y ? We found only three families i n which this was the main means of communicating happiness and anger to the rest of the family. (2) Do you do things for them? Here the trend was i n the d i r e c t i o n of mother and children showing each other by doing something f o r the other. (3) Do you show them through d i r e c t physical contact? We found t h i s to be largely dependent on the ages of the children involved, where they were younger, mother tended to show them through physical contact when she was angry or happy. (4) D 0 you usually not say or do anything at all'? Here we have found father and the I.P. In two cases the I.P. w i l l walk away and four fathers are less l i k e l y to show anger. Looking at the general trends i n thi s area, we found that there was a tendency towards freer expression of feelings to other family members and a tendency towards l e t t i n g them know more d i r e c t l y when they are happy or angry. In four of the families where father had never l e t the family know how he f e l t , we found that a f t e r family group therapy he w i l l now tend to t e l l the family when he i s angry and he also finds i t easier to express happiness. S t i l l i n the area of understanding, we move on to question eight which deals with the matter of consideration given to others feelings when one member speaks up against another family member. We found nine families where at least one family member noted some change i n the amount of consideration given to f e e l i n g s . In three of the f a m i l i e s , G, C, L, the whole family gave more consideration to others fe e l i n g s ; while i n four other of the families that reported change i n t h i s area, E, N, P, B, only one member of the family reported increased consideration with N and B showing i t was mother who changed. It i s i n t e r e s t i n g to note that there were two families 0 and I who reported a negative change i n t h i s area. In 0 , mother reported that she had always been "too considerate of t h e i r f e e l i n g s " but now had become less c a r e f u l of them when expressing h e r s e l f . In I, father and the L P . reported that they give less consideration to,feelings, with father having stated that he had "made too much of i t (feelings) before." In answer to question nine which i s designed i n part to get at the area of feedback, that i s to f i n d the extent to which family members f e e l that they are understood by others, we did not note any s i g n i f i c a n t trends with only four families reporting change i n t h i s area. In cases P and H, we found both families were better able to under-stand the feelings expressed by other family members. In • 0 , they noted added understanding between the I.P. and mother since family group therapy, while i n G family, i t was mother who showed greater understanding of her husband's fe e l i n g s . The other part of this question was directed -91-towards the children, t r y i n g to get at any s i g n i f i c a n t allignments with the parents. 1 Of the t h i r t y - f o u r children who answered t h i s question, we found nineteen who f e l t that there was equal understanding coming from both parents. The l a s t question In the area of understanding i s eleven which attempts to look at the family's a b i l i t y to l i s t e n to what family members say to them. Of our sample of eighteen cases, seven families reported some change In thi s area. With the exception of one family, N, a l l the other families f e l t that there was a d i r e c t relationship between change i n t h e i r a b i l i t y to l i s t e n and family group therapy. The seven families generally f e l t that they l i s t e n more completely and discrlmlnately since therapy and that there have been some changes i n t h e i r "pattern" of l i s t e n i n g . Taking one family 0, we found that i t was mother who noticed a marked change i n this area. She stated that "the words are the least meaningful of what goes on, I now look for other things (non-verbal) that I wasn't sensitive to before family group therapy," Mother further stated that the sessions "sensitized" her to the idea of learning what the feelings of her family are, although she f e l t that she i s not f u l l y tuned in to her husband's f e e l i n g s . Taking another family, 0 , where mother and father f e l t that they l i s t e n e d but both children f e l t that they did not usually l i s t e n to the rest of the family. The ""Tor t h i s section the sample size i s 15, not counting the two one parent families and the one family where only the parents were present f o r the answering of t h i s section. parents reported that they try to l i s t e n and understand the children by putting themselves i n the children's places. At the same time, the children reported that they try to see t h e i r parents' side of most matters now. This family f e l t that change i n this area was d i r e c t l y associated with family group therapy. Mother f e l t that c e r t a i n things were brought out that she had never thought about before. "I got to know the children." Perhaps at this point we could note a few general trends i n the area of i n t e l l e c t u a l understanding and the understanding of f e e l i n g s . F i r s t of a l l , we have noted that i n the area of i n t e l l e c t u a l understanding, family group therapy was e f f e c t i v e In getting family members to give more recognition to meanings, to seek c l a r i f i c a t i o n and to question meanings i n nine cases. Thus r e f e r r i n g to S a t i r , we see where she states that one of her c r i t e r i a for terminating treatment i s when the family members can complete t r a n s a c t i o n s c h e c k , and ask.''' We also noticed a trend i n the area of freeing the I.P.'s within the family to become more active and p a r t i c i p a t e i n communication by questioning t h e i r parents when the messages are not sent or received c l e a r l y . One general trend we noted i n this area of understanding of feelings centres around father. It would appear that father i s a l i t t l e more comfortable in the family, f e e l i n g more a part of It and with this we see some tendency towards freer expression of his feelings so that the family knows when he i s happy or angry. S a t i r , oo. c i t . . p. 176. -93-A n o t h e r t r e n d a p p e a r s t o be i n c r e a s e d u n d e r s t a n d i n g o f f e e l i n g s b e t w e e n h u s b a n d and w i f e . We w i l l now l o o k a t t h e s e c o n d a r e a o f c o m m u n i c a t i o n w h i c h we c o v e r e d i n o u r q u e s t i o n n a i r e . T h i s d e a l s w i t h f a m i l y d i s c u s s i o n s i n w h i c h we have i n c l u d e d a n e x a m i n a t i o n o f t h e f r e q u e n c y w i t h w h i c h t h e s e d i s c u s s i o n s o c c u r w i t h i n t h e f a m i l y , t h e c o n t e n t o f t h e d i s c u s s i o n s , and l a s t l y , t h e i r outcome. The f i r s t q u e s t i o n i n t h i s s e c t i o n i s numbered t h r e e on t h e q u e s t i o n n a i r e and we wanted a p i c t u r e o f t h e f r e q u e n c y w i t h w h i c h f a m i l y d i s c u s s i o n s t a k e p l a c e . We f o u n d f i v e f a m i l i e s who n o t e d some change i n t h e f r e q u e n c y o f f a m i l y d i s c u s s i o n s . F a m i l i e s C and E s t a t e d t h a t t h e y have f a m i l y d i s c u s s i o n s a t l e a s t once a week w i t h C s t a t i n g t h a t t h e r e i s a g r e a t e r d e s i r e f o r f a m i l y d i s c u s -s i o n s and E s t a t i n g t h a t t h e y j u s t seem t o have e v o l v e d a f t e r f a m i l y g r o u p t h e r a p y . I t i s i n t e r e s t i n g t o n o t e t h a t w i t h c a s e s 0 and .P,. t h e r e was a marked d r o p p i n g o f f o f f r e q u e n c y o f d i s c u s s i o n s . B o t h f a m i l i e s u s e d t o have f r e q u e n t d i s c u s s i o n s r i g h t a f t e r f a m i l y t h e r a p y when t h e y w o u l d p r a c t i c e f a m i l y d i s c u s s i o n s a t home. However, t h e r e was a marked d r o p p i n g o f f and now w i l l c a l l a f a m i l y m e e t i n g when n e c e s s a r y . I n P f a m i l y , t h e y u s e d t o have t h e whole f a m i l y t a k e p a r t i n d i s c u s s i o n s b u t now t h e y t e n d t o have o n l y t h o s e i n v o l v e d a t t h e t i m e - - a r e more s p o n t a n e o u s . I n q u e s t i o n f o u r , we a r e e n d e a v o u r i n g t o g e t a t t h e amount o f p a r t i c i p a t i o n o f f a m i l y members I n d i s c u s s i o n s . We f o u n d s e v e n f a m i l i e s who r e p o r t e d some change i n t h i s a r e a and o f t h e s e we f i n d t h r e e f a m i l i e s who h a d r e p o r t e d „ Q 4 -no change i n the frequency of discussions (from previous question). It i s i n t e r e s t i n g to note that four of the families P s C, 0 , N agreed that father talks most in family discussion. However, i t would appear that, although the families agreed that father talks most, the general trend appears to "be quite d i f f e r e n t . It shows that the family members have become more active i n family discussions. There also appears to be a freeing of i n h i b i t i o n s with both the fathers and I.E.'s speaking up more. Hovjever, i t should be noted that in case P, the family stated that there was more harmony i n the home now with the children i n d i f f e r e n t stages of development and being more mature. Therefore, the parents f e l t that the children p a r t i c i p a t e d more i n t e l l i g e n t l y i n family discussion. S t i l l i n the area of p a r t i c i p a t i o n in family discussions i n question f i v e we are endeavouring to get at the i n d i v i d -ual's perception of the opportunity given him to p a r t i c i p a t e i n discussions by the other family members. We found seven families who reported change i n this area. Looking at the general areas in which change took place, we found that i n four f a m i l i e s , P, C, 0 , I, the c h i l d r e n reported that they have more opportunity to speak up since family group therapy. Another i n t e r e s t i n g trend appears to be the increased tendency f o r the I.P.'s to talk more, voicing his opinion i n family discussions. We now move on to look at the amount of time spent i n the discussion of feelings of family members. In question ten, we are t r y i n g to get at some idea of the content of - 9 5 -family discussions. We found eight families who reported some change i n this area, with two of them f e e l i n g that the change was only i n d i r e c t l y related with something that happened i n family group therapy. The general trend among the eight families appears to be i n the d i r e c t i o n of increased time spent i n discussion of f e e l i n g s . I t i s i n t e r e s t i n g to note that four families were made aware of a deficiency i n this area during therapy. In family 0 they stated that during a therapy session they would make a statement and the therapist would ask them how they f e l t about t h i s , and this started them thinking along these l i n e s . Our l a s t question in this section deals with the outcome of family discussions. More s p e c i f i c a l l y , question seven asks the family i f discussions usually end i n quarrels and i f so, what do they see as s e t t i n g things o f f . We found eight families who reported change i n the frequency that family discussions end i n quarrels. Six families f e l t that family discussions did not usually end i n quarrels. In these f a m i l i e s , C, L, G, H, and I, we noted a marked decrease i n the number of quarrels. I t i s i n t e r e s t i n g to note that family 0 reported an increase i n the amount of q u a r r e l l i n g since family group therapy. They stated that they had more quarrels now because the family members have more to say. In family G, they stated that "before family group therapy there was much y e l l i n g and screaming, now we s i t and t a l k , l i s t e n i n g more to what i s being said and presenting our own side." It i s i n t e r e s t i n g to draw some generalizations from - 9 6 -our findings i n this area of communication. In our sample size of eighteen, ten families showed change i n four or more sections, with four families showing change i n ten or more of the sections on this subject. Referring back to the two categories under communication—understanding and family d i s c u s s i o n — i t would appear from our results that family group therapy brings about greater change i n the area of understanding, both I n t e l l e c t u a l and f e e l i n g . Taking the percentage of t o t a l changes, we found understanding with 57$ of the t o t a l change and family discussions with 4 3 $ of the t o t a l change i n communication. We have given no consideration to those eight families who recorded no change In the area of communication. I t should be stated, that just because these cases record no change, we cannot conclude that they are e i t h e r functioning poorly or very well i n communications within the family. Rather we might state that family group therapy appears to have had l i t t l e or no l a s t i n g a f f e c t on these eight f a m i l i e s . We found that of the ten families who reported change, six were diagnosed by the therapists as either leaderless or disconnected f a m i l i e s . 1 Table 29. Family Type and Change i n Communication Change No Change Disconnected and Leaderless 6 (60$) 2 (25$) Others 4 ( 4 0 $ ) 6 (75$) : ••':£ '-Appendix VI on Family Types - 9 7 -I t would appear that the leaderless and disconnected families showed the most frequent change i n communication. We might speculate that either they needed and sought change more ac t i v e l y i n this area, or they were more amenable to the treatment, we are unable to specify which of these i s true. If we-take the number of interviews that our sample group had, we see that a l l ten families had four or more interviews. Prom Table 30, we can draw some conclusions about the eff e c t s on communication. We might speculate that either better communication channels within the family lead to more interviews, or there i s a d e f i n i t e c o r r e l a t i o n between the number of Interviews and the amount of change i n family communication. Table 30. Number of Interviews and  Change i n Communication No. of interviews Change No Change 3 or less 0 ' [ v ^ ' 4 (50$) 4 or more 10 (100$;) 4 (50$) The l a s t table i n t h i s section deals with comparison between the socio-economic l e v e l of our sample f a m i l i e s , using the Holllngshead Scale, and recorded change In the area of communication. We might conclude that families com-ing from a higher socio-economic l e v e l have better results i n family group therapy. Frances Scherz and Holllngshead 1 1 Scherz, op. cit.«, p. 135. - 9 8 -mention that people from the higher socio-economic levels w i l l be better able to verbalize and thus t h e i r higher l e v e l of verbal s o p h i s t i c a t i o n w i l l stand them i n good sted i n family group therapy. Table 31• Socio-economic Level and  Change i n Communication Socio-economic l e v e l Change No Change High 6 (60$) 3 (37$) Low 4 (40$) .5 (63$) Intra-Familial Relationships. The following analysis i s based upon section six of the questionnaire. This section consisted of eight questions designed to e l i c i t the f a m i l i e s ' perceptions of change i n th e i r i n t r a - f a m i l i a l r e l a t i o n s h i p s , and whether they attributed change to p a r t i c i p a t i o n i n family group therapy. The f i r s t four questions were directed to a l l the family members who had participated i n family group therapy. The remaining four questions were directed to the parents only, and were designed primarily to e l i c i t responses concerning the parents perceptions of change i n the marital r e l a t i o n -ships. The forH^^^pie^c|uestions i s such that the respon-dents are f i r s t asked for th e i r opinion concerning a p a r t i c u l a r area of i n t r a - f a m i l i a l r e l a t i o n s h i p s , then asked to describe any change which they f e e l has taken place i n this area as a r e s u l t of family group therapy. It should be noted perhaps, that where family members report change as a re s u l t of family group therapy, i t i s not -99-possible to assess the degree of "change which has taken place., but only the fac t that they perceive change. Question one asked family members whether they f e l t they mainly agreed,, or disagreed., as a family. Of the eighteen families replying, thirteen reported that they mainly agreed as a family. Nine families reported that they f e l t they had changed i n this area as a re s u l t of family group therapy. Of these nine f a m i l i e s , eight described change in terms of increased agreement. The ninth family 0 , stated that p r i o r to family group therapy they had only agreed on the surface, whereas they now were able to voice t h e i r disagreements and recognize that as individuals they had a wide diversion of i n t e r e s t s . Two families attributed t h e i r increased agreement s p e c i f i c a l l y to increased communication between family members C and G. One family reported that they agreed more now because p r i o r to therapy they had trouble deciding what was important .{?).. In two of the families only the parents f e l t that there was increased agreements. Question two dealt with each family members opinion as to which family members disagreed most often when there were disagreements i n the family. Responses varied considerably within i n d i v i d u a l families and from family to family. Seven fam i l i e s , C, H, E 5 G, I. 0 , and L reported some change as a r e s u l t of therapy. In family C a l l members f e l t the children disagreed most often, but f e l t that disagreement took place mainly between parents and children, and a l l family members reported an improvement i n solving - 1 0 0 -disagr-eements. I n f a m i l y G, d i s a g r e e m e n t s t o o k p l a c e m a i n l y b e t w e e n t h e I.P. and o t h e r members. The p a r e n t s f e l t t h a t as a r e s u l t c f t h e r a p y t h e f a t h e r a l l o w e d d i s -a g r e e m e n t s t o take p l a c e . The I.P. s t a t e d that he a g r e e d more w i t h his sibling now, and t h e sibling reported a n i n c r e a s e d a b i l i t y t o d i s a g r e e more f i r m l y . In f a m i l y H, t h e mother o n l y r e p o r t e d change, and she f e l t t h a t the;-c h i l d r e n f o u g h t l e s s . In f a m i l y I a l l members f e l t t h a t t h e mother and t h e I.P. d i s a g r e e d most o f t e n . T h ey r e p o r t e d change i n terms o f t h e d i s a g r e e m e n t s t i l l e x i s t -i n g / ' b u t t h e y "cope with i t b e t t e r " . I n f a m i l y L d i s a g r e e m e n t was m a i n l y between t h e I.P. and s i b l i n g s , and t h e I.P. reported t h a t t h e s e d i s a g r e e m e n t s a r e l e s s f r e q u e n t s i n c e t h e r a p y . F a m i l y C f e l t d i s a g r e e m e n t s were " s h a r e d around"., and they saw change i n terms o f a n a b i l i t y t o d i s a g r e e now, and f e l t t h i s was a p o s i t i v e c h a n g e . I n Q u e s t i o n three f a m i l y members were a s k e d , "when t h i n g s 'go wrong' in the f a m i l y , does some one f a m i l y member u s u a l l y g e t blamed?* 1 The r a t i o n a l e f o r t h i s q u e s t i o n was t o t r y t o d e t e r m i n e the p r e s e n c e o f a f a m i l y " s c a p e g o a t " . The r e s p o n s e s were q u i t e v a r i e d , , b u t t h r e e f a m i l i e s s t a t e d q u i t e c l e a r l y t h a t one. p a r t i c u l a r member t o o k a l l t h e b l a m e . (D.. H„ K„) o f t h e s e t h r e e , f a m i l i e s D a n d K r e p o r t e d no change a t t r i b u t a b l e t o t h e r a p y . I n f a m i l y H o n l y t h e I.P.. f e l t t h e r e was any c h a n g e , and he f e l t t h a t he now t o o k a b i t more blame,, r a t h e r t h a n i t a l l g o i n g t o h i s s i b l i n g . Two f a m i l i e s , , I and P f e l t t h a t p r i o r t o f a m i l y g r o u p t h e r a p y one member t o o k a l l t h e b lame, b u t -101-s i n c e t h e r a p y t h i s no l o n g e r o c c u r s . F a m i l y 0 r e p o r t e d t h a t t h e m other u s e d t o g e t a l l t h e blame, b u t now she i s more a s s e r t i v e . , and f a t h e r t a k e s more now. Q u e s t i o n f o u r was d e s i g n e d t o t r y and g e t a p i c t u r e o f " a l l i a n c e s " w i t h i n t h e f a m i l y g r o u p s , and any changes w h i c h m i g h t have o c c u r r e d and were a t t r i b u t e d t o t h e r a p y . S i x o f t h e e i g h t e e n f a m i l i e s r e p o r t e d some change w h i c h t h e y a t t r i b u t e d t o t h e r a p y . I n f o u r o f t h e s e f a m i l i e s , G, 0 , P 5 a n d H, t h e p a r e n t s f e l t t h a t a s a r e s u l t o f t h e r a p y t h e y were more c l o s e l y a l i g n e d and s u p p o r t i v e o f one a n o t h e r , and saw t h i s as b e i n g b e n e f i c i a l t o t h e f a m i l y . F a m i l y G saw a change i n t h a t t h e f a t h e r i s now more I n v o l v e d w i t h t h e f a m i l y . F a m i l y C r e p o r t e d a l l i a n c e s b e tween p a r e n t s and c h i l d r e n , a n d a l l members s t a t e d t h e r e was a change s i n c e t h e r a p y i n t h a t t h e f a m i l y now gave more s u p p o r t t o t h e I.P. I n t h i s area,, change a p p e a r e d t o t a k e p l a c e m a i n l y w i t h i n t h e m a r i t a l r e l a t i o n s h i p . As s t a t e d p r e v i o u s l y , q u e s t i o n s f i v e t o e i g h t were d i r e c t e d t o t h e p a r e n t s o n l y . T h e r e were two o n e - p a r e n t f a m i l i e s w i t h i n t h e sample, D and F, and s i n c e t h e q u e s t i o n s were n o t a p p l i c a b l e t h e sample i s r e d u c e d t o s i x t e e n f o r t h e s e q u e s t i o n s . Q u e s t i o n f i v e a s k e d p a r e n t s i f t h e y m a i n l y a g r e e d o r d i s a g r e e d u p o n t h i n g s t h a t were i m p o r t a n t t o them. Two c o u p l e s , N a n d Q,„ s t a t e d t h e y d i s a g r e e d , t h r e e w e r e n ' t s u r e , and t h e r e s t s t a t e d t h e y a g r e e d . F o u r c o u p l e s C, G, F, and P r e p o r t e d some change i n t h i s a r e a w h i c h t h e y - 1 0 2 -a t t r i b u t e d t o f a m i l y g r o u p t h e r a p y . T hey e x p r e s s e d t h e change m a i n l y i n t e r m s o f i n c r e a s e d s o l i d a r i t y and. t e r m s o f c o n s i d e r i n g and a c c e p t i n g t h e o t h e r ' s p o i n t o f v i e w more. One c o u p l e , • C , s t a t e d s p e c i f i c a l l y t h a t t h e y " l i s t e n e d more",, and t h a t t h e y had "more c o n f i d e n c e i n t h e i r r o l e s " . In. t h r e e cases,, I , L , and N, t h e m others f e l t t h e r e had b e e n a change i n t h i s a r e a s i n c e t h e r a p y b u t t h e f a t h e r s d i d n o t . Two e x p r e s s e d change i n t e r m s o f i n c r e a s e d a greement r e g a r d i n g t h e r a i s i n g o f c h i l d r e n a n d t h e h a n d l i n g o f money. . Q u e s t i o n s i x d e a l t w i t h t h e p a r e n t s way o f h a n d l i n g d i s a g r e e m e n t . F i v e of t h e c o u p l e s , G, H, L, N, a n d P r e p o r t e d change as a r e s u l t o f t h e r a p y . T h r e e o f t h e s e s t a t e d t h a t t h e y " t a l k t h i n g s o u t more now", and f e e l t h e y h a v e f e w e r d i s a g r e e m e n t s as a r e s u l t . The o t h e r two d i d n o t h a n d l e d i s a g r e e m e n t t h r o u g h d i s c u s s i o n , b u t b o t h f e l t t h a t t h e y were b e g i n n i n g to a g r e e more. I n two c a s e s one o f t h e p a r t n e r s r e p o r t e d change and t h e o t h e r p a r t n e r d i d n o t . E and 0. One of t h e s e s t a t e d t h a t h e r h u s b a n d a l l o w s h e r to d i s a g r e e more now. I n q u e s t i o n s e v e n t h e p a r t n e r s were a s k e d i f t h e i r m a r r i a g e had t u r n e d o u t m a i n l y as t h e y had hoped i t w o u l d , and i f t h e y saw any change i n t h e i r t h i n k i n g as a r e s u l t o f t h e r a p y . One c o u p l e d i d n o t r e p l y , so sample i s r e d u c e d t o f i f t e e n . . . F o u r c o u p l e s C , L , N, and P saw a d e f i n i t e c hange. C o u p l e C f e l t t h a t t h e i r m a r r i a g e h a d t u r n e d o u t b e t t e r t h a n t h e y had hoped, and a t t r i b u t e d some o f t h i s f e e l i n g t o t h e i r e x p e r i e n c e o f t h e r a p y . They s a i d t h e i r t o l e r a n c e had -103-grown, and the husband stated-that he was happier to see his wife f e e l i n g happier. Couple L f e l t t h e i r marriage had turned out as they had hoped, and f e l t that t h i s f e e l i n g was a res u l t of therapy. Couple N f e l t that t h e i r marriage had not turned out as they had hoped, but as a r e s u l t of therapy t h e i r standards had changed, and they were now "heading that way". Couple P f e l t much more s a t i s f i e d with t h e i r marriage since therapy. They stated that they f e l t more of a.team now. In two cases, ore partner reported change and the other did not. One wife f e l t that she and her husband were closer since therapy. In the other case the husband stated that the marriage had not turned out as he had hoped, but since therapy he found i t easier to accept c e r t a i n things. In question eight the parents were asked i f t h e i r sexual, relationship had changed since family group therapy. Two did not reply, sample i s fourteen. Three couples G, N, and I stated that t h e i r sexual r e l a t i o n s h i p was more sat i s f a c t o r y than before therapy. In two cases, H and L the.fathers r e p l i e d "more sa t i s f a c t o r y " and the mothers r e p l i e d that the rel a t i o n s h i p was the same. The remaining couples r e p l i e d that t h e i r r e l a t i o n s h i p was the same as before. Fourteen couples r e p l i e d to t h i s question. At the end of the eight questions the parents were asked again i f they f e l t that any changes i n the areas mentioned had been brought about as a r e s u l t of family group therapy. Nine reported that changes were a r e s u l t of the therapy. -104-Summarv of Findings. 1. Of the eighteen families interviewed, nine families reported some change i n the area of i n t r a - f a m i l i a l relationships which they f e l t was related to t h e i r p a r t i c i p a t i o n i n family group therapy. 2 . The changes reported by these nine families were seen by the families to. be; p o s i t i v e changes. 3. The remaining nine families reported no changes i n the area of i n t r a - f a m i l i a l relationships which they f e l t were attributable to family group therapy. 4. Of the nine families reporting change, there were no instances of i s o l a t e d change. Families reporting change i n one area of i n t r a - f a m i l i a l relationships tended to report changes i n other areas as w e l l . 5 . The area i n which change was reported most frequently was the area of agreement--disagreeraent. The responses usually indicated e i t h e r increased agreement, or increased tolerance of?tdlsagreement, on the part of family members• 6. Where improvement i n i n t r a - f a m i l i a l relationships was reported, i t tended to be stated i n terms of increased communication and understanding. 7 . There was a tendency for parents to report more change than the children. This could i n part be. a function of the design of the question, or greater verbal a b i l i t y on the parents part. However, the impression was given that most of the changes took place i n the marital r e l a t i o n s h i p . An analysis of the data on i n t r a - f a m i l i a l r e l a t i o n -ships using the variables of (1) socio-economic status -105-( H o l l i n g s h e a d I n d e x ) ; (2) number o f i n t e r v i e w s ; (3) F a m i l y T y pe; (4) d i a g n o s t i c c a t e g o r y o f I.P., y i e l d e d t h e f o l l o w i n g f i n d i n g s . a . F a m i l i e s r e p o r t i n g some change t e n d e d t o f a l l i n t o H i g h s o c i o - e c o n o m i c g r o u p . b . F a m i l i e s r e p o r t i n g no change t e n d e d t o f a l l i n t o t h e Low s o c i o - e c o n o m i c g r o u p . T a b l e 32. Change I n I n t r a - F a m l l l a l R e l a t i o n s h i p a s R e l a t e d t o S o c i o - E c o n o m i c S t a t u s H i g h Low Change 6 (67$) 3 (33$) No Change 3 (33$) 6 ( 6 7 $ ) 9 9 a . F a m i l i e s r e p o r t i n g some change had f o u r o r more i n t e r v i e w s . b . F a m i l i e s r e p o r t i n g no change t e n d e d t o have h a d t h r e e o r l e s s I n t e r v i e w s . c . A g r e a t e r p e r c e n t a g e o f t h e f a m i l i e s r e p o r t i n g change had e i g h t o r more i n t e r v i e w s . d. A. g r e a t e r p e r c e n t a g e o f t h e g r o u p r e p o r t i n g no change had l e s s t h a n e i g h t i n t e r v i e w s . e. The mean number o f i n t e r v i e w s f o r t h e g r o u p r e p o r t i n g some change was 1 2 . 2 f . The mean number o f i n t e r v i e w s f o r t h e g r o u p r e p o r t i n g no change was 5-7 T a b l e 33• Change i n I n t r a - F a m i l l a l R e l a t i o n s h i p s  as R e l a t e d t o Number o f I n t e r v i e w s 1 - 3 I n t . 4 o r more I n t . Change 0 (0$) 9 (100$) No Change 4 (44$) 5 ( 5 6 $ ) 4 14 -106-Table 34. Change i n Intra-Famillal Relationships  as Related to Number of Interviews 1 - 7 Int. 8 or More Int. Change 3 (33$) 6 (67$) No Change 6 (67$) 3 (33$) 9 9 10. a. A greater percentage of the families reporting change were families categorized as Leaderless and Disconnected. b. A greater percentage of the families reporting no change were categorized.as Restricted, D i c t a t o r i a l , Contrlcted and Chaotic. Table 35 • Change i n Intra-Famillal Relationships  as Related to Family Type Change Leaderless and ; Disc onne c t e d Others 6 (67$) 3 (33$) No Change 3 (33$) 6 (67$) 9 9 11. A comparison of the change and no change groups by diagnostic category of the I.P.. yielded no s i g n i f i c a n t f i n d ing. CHAPTER IV SUMMARY AND CONCLUSIONS Summary o f M a j o r F i n d i n g s A r e v i e w o f t h e s i x s e c t i o n s o f d a t a a n a l y s i s h as y i e l d e d t h e f o l l o w i n g f i n d i n g s . 1. Of t h e e i g h t e e n f a m i l i e s i n t e r v i e w e d f o r t h i s s t u d y , a p p r o x i m a t e l y 50$ o f t h e f a m i l i e s r e p o r t e d some change i n f a m i l y f u n c t i o n i n g w h i c h t h e y v i e w e d as p o s i t i v e , and w h i c h t h e y a t t r i b u t e d t o t h e i r p a r t i c i p a t i o n i n f a m i l y g r o u p t h e r a p y . 2 . T h e r e were no r e p o r t s o f d e t e r i o r a t i o n i n f a m i l y f u n c -t i o n i n g a s c r i b e d t o f a m i l y g r o u p t h e r a p y . 3. The f a m i l i e s r e p o r t i n g changes t e n d e d t o r e m a i n c o n s t a n t t h r o u g h o u t t h e s i x s e c t i o n s o f a n a l y s i s , so t h a t f a m i l i e s r e p o r t i n g change i n one a r e a o f f a m i l y f u n c t i o n -i n g t e n d e d t o be t h e same f a m i l i e s who r e p o r t e d c h a n g es i n o t h e r a r e a s . The same a p p l i e d ,to f a m i l i e s r e p o r t -i n g no c h a n g e . 4. The a r e a s o f f a m i l y f u n c t i o n i n g where change was r e p o r t e d most f r e q u e n t l y were t h e a r e a s o f (1) r o l e f u n c t i o n i n g ; (2) c o m m u n i c a t i o n ; (3) i n t r a - f a m i l l a l r e l a t i o n s h i p s , i n t h a t o r d e r . L i t t l e o r no change was r e p o r t e d i n t h e a r e a s o f (1) u s e o f community r e s o u r c e s ; (2) e x t e r n a l f a m i l y r e l a t i o n s h i p s ; a n d (3) o c c u p a t i o n and e d u c a t i o n . ft -108-'•j An a n a l y s i s o f t h e d a t a f r o m e a c h s e c t i o n , u s i n g t h e v a r i a b l e s o f . ( 1 ) S o c i o - e c o n o m i c s t a t u s ( H o l l l n g s h e a d I n d e x ) ; ( 2 ) number of I n t e r v i e w s ; ( 3 ) F a m i l y T y p e ; and ( 4 ) T h e r a p i s t ' s I m p r e s s i o n s , has y e i l d e d f i n d i n g s common t o e a c h s e c t i o n . They a r e t h e f o l l o w i n g . (See T a b l e s No. 3 2 t o 3 5 ) . 5 . a) F a m i l i e s who r e p o r t e d change t e n d e d t o f a l l i n t o t h e H i g h C l a s s g r o u p , b) F a m i l i e s r e p o r t i n g no change t e n d e d t o f a l l i n t o t h e Low C l a s s g r o u p . 6 . a) F a m i l i e s who r e p o r t e d change t e n d e d t o have had f o u r o r more i n t e r v i e w s , b) F a m i l i e s r e p o r t i n g no change t e n d e d t o have had t h r e e o r l e s s , i n t e r v i e w s . 7 . a) A g r e a t e r p e r c e n t a g e o f t h e f a m i l i e s r e p o r t i n g change were f a m i l i e s who were c a t e g o r i z e d as L e a d e r l e s s and D i s c o n n e c t e d . b) A g r e a t e r p e r c e n t a g e o f the f a m i l i e s r e p o r t i n g no change were f a m i l i e s who were c a t e g o r i z e d as D i c t a t o r i a l , R e s t r i c t e d , C o n s t r i c t e d and C h a o t i c . 8. A c o m p a r i s o n o f t h e r a p i s t ' s i m p r e s s i o n s r e g a r d i n g change a t t h e t i m e o f c a s e - c l o s i n g , w i t h t h e f a m i l i e s p e r c e p -t i o n s o f change a t t h e t i m e o f t h e r e s e a r c h i n t e r v i e w s , one y e a r o r more l a t e r , r e v e a l s some d i s c r e p a n c y b etween t h e t h e r a p i s t ' s i m p r e s s i o n o f change an d t h e f a m i l i e s p e r c e p t i o n o f c h a n g e . The t h e r a p i s t s r a t e d more f a m i l i e s a s h a v i n g c h a n g e d t h a n d i d t h e f a m i l i e s them-s e l v e s . I t must be remembered i n c o n n e c t i o n w i t h t h i s t h a t t h e r a t i n g s by t h e r a p i s t s and f a m i l i e s o c c u r r e d a t -109-d i f f e r e n t p o i n t s i n t i m e . The m a t e r i a l d e a l t w i t h t h u s f a r r e p r e s e n t s what we f e e l were t h e major f i n d i n g s o f o u r s t u d y . T h e r e a r e some o t h e r f e a t u r e s o f t h e d a t a t h a t we f e e l a r e w o r t h m e n t i o n i n g . 9- P a r e n t s t e n d e d t o r e p o r t change more f r e q u e n t l y t h a n c h i l d r e n . 1 0 . The two o n e - p a r e n t f a m i l i e s i n t h e s t u d y c o n s i s t e n t l y r e p o r t e d no change i n f a m i l y f u n c t i o n i n g . 11 . N e g a t i v e a t t i t u d e s t o f o l l o w - u p i n t e r v i e w s were f r e q u e n t , l e a d i n g t o d i f f i c u l t y i n a s s e m b l i n g a random s a m p l e . 1 2 . A n a l y s i s s u g g e s t e d a f a i r l y h i g h d e g r e e o f c o n c e n s u s between t h e p a r e n t s on most a s p e c t s o f f a m i l y l i f e . T h i s s u g g e s t s t h a t t h e i r r e p o r t s i n o t h e r a r e a s may a l s o have b e e n r e l i a b l e . Summary T a b l e on G e n e r a l C h a r a c t e r i s t i c s  o f a l l t h e Changes n o t e d by t h e  E i g h t e e n F a m i l i e s I n t e r v i e w e d . G e n e r a l C h a r a c t e r i s t i c s o f change i n a l l f a m i l i e s i n a l l a r e a s . The a r e a s o f g r e a t e s t change were i n t h e i n t e r n a l a r e a s o f f a m i l y f u n c t i o n i n g , t h o s e b e i n g c o m m u n i c a t i o n , i n t e r n a l f a m i l y r e l a t i o n s h i p s and r o l e p e r f o r m a n c e . More f a m i l i e s f e l t t h a t t h e y had c hanged i n r o l e p e r f o r m a n c e t h a n i n any o t h e r a r e a . T h i r t e e n o f t h e e i g h t e e n f a m i l i e s n o t i n g a p r e d o m i n a t e l y p o s i t i v e c h a n g e . C o m m u n i c a t i o n was t h e a r e a o f s e c o n d g r e a t e s t improvement w i t h t e n f a m i l i e s n o t i n g change c l o s e l y f o l l o w e d by i n t e r f a m i l i a l r e l a t i o n -s h i p s w i t h n i n e p o s i t i v e changes r e c o r d e d . T e n f a m i l i e s r e t a i n o r g a i n e d p o s i t i v e a t t i t u d e s t o w a r d t h e a g e n c y w h i l e n i n e were e s s e n t i a l l y n e g a t i v e . The e x t e r n a l a r e a s showed Table 36 The General C h a r a c t e r i s t i c s of the 18 Families Interviewed, as to Socio Economic Level, Number of Interviews, Therapist's Ratings, and as to the Changes Recorded i n each area of our Questionnaire. x no change heg. - negative agency attitude at least some change pos. - po s i t i v e agency attitude F a m i 1 y Type Socio Economic Level No. of Inter-views Thera-p i s t 1 s ratings Communi-cation External Family Relation-ships & Use of Informal resources Internal Family Relation-ships External Relation-ships & Performance Role Perform-ance Agency Attitudes A c o n s t r i c t e d low 13 y X X X X X neg. B chaotic low 8 y J X X X • pos. c c o n s t r i c t e d high 6 v/ X y X • pos. D leaderless low 12 X X X X X neg. E leaderless low 13 X v/ • y / y neg. F chaotic high 3 y X X X X X pos. G d i c t a t o r i a l low 12 V V X y X y neg. H leaderless high 15 J y X y • y neg. I chaotic high 5 v/ V X y X y pos. J d i c t a t o r i a l low 1 X X X X X y pos. K leaderless high 1 X X X X X neg. L leaderless low 8 y • y y y pos. M disconnected low 6 X X X X y pos. N disconnected high 7 / V y y y y pos. 0 disconnected high 24 X V y y X y pos. P disconnected high 20 y / y V y pos. Q co n s t r i c t e d low 1 X X X X X X neg. R d i c t a t o r i a l high* 7 X X X •<••' X neg. Table 3 7 Socio-Economic Level of f a m i l i e s as i t i s r e l a t e d to change in six areas of family functioning. Percentages given indicate percentage of f a m i l i e s noting change or i n agency attitudes remaining p o s i t i v e . Socio-Economic Level Communicat ion (No. and %> Report ing Change) External Family Relationships & Use of Informal resources (No. and % Reporting Change) Internal Family Relationships (No. and % Reporting Change) External Perform-ance and Relation-ships (No. and % Reporting Change) Role Performance (No. and % Reporting ,Change) Agency Attitudes (No. and % Reporting Change) low 9 4 ( 4 4 . 4 7 . ) 1 ( 1 1 . 2 7 c ) 2 ( 3 3 . 3 % ) 1 ( 1 1 . 2 % ) 6 ( 6 6 . 6 % ) 3 ( 3 3 . 3 % ) high 9 6 ( 6 6 . 6 7 c ) 2 ( 3 3 . 3 7 . ) 6 ( 6 6 . 6 % ) 2 ( 3 3 . 3 % ) 6 ( 6 6 . 6 % ) - 6 ( 6 6 . 6 % ) Table 3 8 Therapists Impressions of improvement as i t i s r e l a t e d to change in six. areas of family functioning, Thera-p i s t s Impres-sions Commun i cation (No, and •% Reporting Change) External Family Relationships & Use of Informal resources (No, and % Reporting Change) Internal Family Relationships (No. and % Reporting Change.) External Perform-ance, and Relation-ships (No, and % Reporting Change) Role Performance (No. and % Reporting Change) Agency Attitudes (No. and % Reporting Change.) No Improve-ment 4 2 ( 5 0 % ) 2 ( 5 0 % ) 2 ( 5 0 % ) 1 ( 2 5 % ) 2 ( 5 0 % ) 2 ( 5 0 % ) Some Improve-ment 1 4 8 ( 5 7 . 2 % ) 2 (14.1%) 7 ( 5 0 % ) 4 ( 2 8 . 4 % ) . 1 0 ( 7 1 . 3 % ) 9 ( 6 4 , 2 % ) Table 3 9 The number of interviews as r e l a t e d to change i n six areas of family functioning. No. of Inter-views Communication (No. and % Reporting Change) External Family Relationships & Use of Informal resources (No. and % Reporting Change) Internal Family Relationships (No. and % Reporting Change) External Perform-ance and Relation-ships (No'. and % Reporting Change) Role Performance (No, and % Reporting Change) Agency Attitudes (No. and % Reporting Change) 3 or less 3 0 ( 0 % ) 0 - ( 0 % ) 0 ( 0 % ) 0 ( 0 7 c ) 1 ( 3 3 % ) 1 ( 3 3 % ) 4 or more 1 5 1 0 ( 6 6 % ) 5 ( 3 3 7 c ) 9 ( 6 0 7 o ) 5 ( 3 3 % ) 1 1 ( 7 3 % ) 1 0 ( 6 6 % ) Table 4 0 No, of fami l i e s i n each type reporting changes i n each area of family functioning, Type of family Communicat ion, No, Reporting Change. External Family Relationships & Use of Informal resources. No, Reporting Change Internal Family Relationships, No, Reporting Change External Perform- . ance. and Relation-ships . No. Reporting Change Role Performance, No, Reporting Change Agency Att i t u d e s , No. Reporting Change leaderless 3 2 3 3 2 2 con-s t r i c t e d 1 0 1 0 1 1 chaotic 2 0 1 0 2 3 discon-nected 3 3 3 2 4 4 d i c t a -t o r i a l 1 0 1 0 3 1 -113-less change with only f i v e families noting change in each of External Family Relationships and Use of Informal Resources and External Performance and Relationships. There could be- several possible reasons for the greater changes i n the i n t e r n a l areas. Family group therapy is aimed d i r e c t l y at i n t e r n a l family functioning and external gains are secondary. Internal dysfunction was usually the r e f e r r i n g problem and the one the families were most motivated to control. Changes In i n t e r n a l functioning are mainly i n the perception by the family and r e l i e s on no external forces. There tended to be changes i n a l l areas of i n t e r n a l functioning i f there was a change i n one. Changes did not seem to occur i n i s o l a t i o n . In only three f a m i l i e s , M, J , and R, there was an i s o l a t e d change i n role performance noted. A l l changes were po s i t i v e except i n one instance D family i n role performance noted a negative change. Coneluslons. Several tentative conclusions can be drawn from the major'findings in t h i s study. These conclusions apply only to the eighteen families studied. F i r s t , there are indications that family group therapy i s a v a l i d treatment approach3 generally, i n e f f e c t i n g change i n family function-ing. There i s also evidence that s p e c i f i c goals of t h i s treatment are achieved. I t Is reasonable to assume that changes in role performance, changes i n communications patterns, and changes i n i n t r a - f a m i l i a l r e l a t i o n s are effected. In addition, there seems to be a tendency for - 1 1 4 -change t o be e f f e c t e d i n r e l a t i o n s e x t e r n a l t o t h e f a m i l y , a l t h o u g h t o a somewhat l e s s e r d e g r e e . Change i n one a r e a o f f a m i l y f u n c t i o n i n g , ( i . e . r o l e s ) t e n d s t o be c o r r e l a t e d t o change i n o t h e r a r e a s . T h e s e changes seem t o become i n c r e a s i n g l y a p p a r e n t t h r o u g h t i m e , w i t h l e n g t h o f t r e a t -ment. F i n a l l y , t h e t h e r a p e u t i c g o a l o f e f f e c t i n g symptom r e l i e f has b e e n o b s e r v e d o n l y i n d i r e c t l y , a l t h o u g h i m p r e s s i o n s g a i n e d by t h e i n t e r v i e w e r s i n d i c a t e t h a t t h i s a r e a too,, v a r i e s d i r e c t l y w i t h t h e o t h e r a r e a s o f f a m i l y f u n c t i o n i n g . The g r e a t e s t change seemed t o be o b s e r v e d by t h e f a m i l i e s a t t i m e o f t r e a t m e n t o r i m m e d i a t e l y a f t e r . No r e a l c o n c l u s i o n s c o u l d be drawn on t h e l o n g t e r m e f f e c t s , l a r g e l y b e c a u s e o f t h e s h o r t t i m e s p a n o f t h e s.tudy a n d b e c a u s e o f t h e l a c k o f I n f o r m a t i o n o b t a i n e d a t t h e o n s e t o f t r e a t m e n t , f r o m w h i c h t o b a s e a c o m p a r i s o n w i t h f o l l o w - u p . I t was f o u n d t h a t t h e t h e r a p i s t s ' i m p r e s s i o n s t e n d t o be h i g h e r t h a n t h e f a m i l i e s s e l f r a t i n g s a y e a r l a t e r . P e r h a p s t h i s t o o , .may r e s u l t f r o m t h e t i m e f a c t o r i n v o l v e d , p r o d u c i n g • d i v e r g e n c i e s between f a m i l i e s and t h e r a p i s t s as t h e y r a t e i n r e t r o s p e c t . •There a r e I n d i c a t i o n s t h a t change i s e f f e c t e d by f a m i l y g r o u p t h e r a p y , n o t o n l y i n t h e b e h a v i o u r o f t h e i d e n t i f i e d p a t i e n t , b u t a l s o i n t h e b e h a v i o u r o f o t h e r f a m i l y members as w e l l . , T h i s i s c o n s i s t a n t w i t h t h e . g o a l s and i m p r e s s i o n s o f t h e t h e r a p i s t s . As was s u g g e s t e d by some o f t h e f a m i l i e s i n t e r v i e w e d , many o f t h e s e c h a n g e s , e s p e c i a l l y i h t h e c h i l d r e n , c o u l d be e x p l a i n e d by t h e m a t u r a t i o n a l p r o c e s s . However, e v i d e n c e s u g g e s t i n g f a i r l y e x t e n s i v e -115 -changes i n the behaviour of parents, p a r t i c u l a r l y In the sphere of marital r e l a t i o n s , leads us to believe that there are r e c i p r o c a l e f f e c t s of treatment among family members. Some of the questions raised by the researchers with regard to what c h a r a c t e r i s t i c s of families are most conclusive to change through family group therapy have provided c e r t a i n clues from which future research can be guided. F i r s t of a l l i t appears as i f assessment of family i n t e r a c t i o n patterns may be useful i n predicting success i n treatment. "Leaderless" and "disconnected" family types show tendencies to change more readily with treatment, while "chaotic", " d i c t a t o r i a l " , and "constricted" family types seem to change l e a s t . These tendencies appear to vary independently with other family c h a r a c t e r i s t i c s such as socio-economic class and pathological symptom formation, although a more sophisticated study may show otherwise. Leaderless families may be p o t e n t i a l l y more democratic i n nature and therefore . more receptive to higher modes of p a r t i c i p a t i o n i n communica-tions between family members.. D i c t a t o r i a l families may on the other hand be more r e s i s t i v e to treatment and may resent disruption of t h e i r communication patterns,by the therapist. •The l a t t e r situations may be a f r u i t f u l area f o r future invest i g a t i o n p a r t i c u l a r l y with regard to the problem of drop-outs i n the i n i t i a l stages of treatment. Improvement in d i f f e r e n t i a l diagnosis of families may aid the therapist to develop a more f l e x i b l e approach i n use of techniques i n order that he may overcome i n i t i a l resistances, i n h i b i t i o n s , or inadequacies i n the family's a b i l i t y to make use of -116-treatment. .Similarly, findings In this study suggest that lower class families do not respond as well to t h i s form of t r e a t -ment as do higher class f a m i l i e s . Some of the implications that can be drawn from these findings may have future con-sequences i n si m i l a r refinement of diagnosis and techniques as discussed' above. In addition, we may speculate that c e r t a i n families may not be responsive to family group therapy, or they may require a d d i t i o n a l preliminary or supplementary forms of treatment i n conjunction with family group therapy. Perhaps apparent class differences observed with regard to verbal f a c i l i t y , communication patterns, and role perception may have some bearing on t h i s matter. Optimal number of family members i n treatment was not i studied, nor were other aspects of family structure such as age range, foster parents, and so forth,., »However, the two one-parent families .included i n the study showed no appar-ent response to treatment. Therefore i t would be reasonable to hypothesize that family structure, socio-economic c l a s s , family type; and other c h a r a c t e r i s t i c s of the family may be predictive i n success through treatment. More intensive study i n t h i s area may reveal various configurations of family c h a r a c t e r i s t i c s reacting s p e c i f i c a l l y to p a r t i c u l a r treatment approaches to therapy. With regard to the treatment process i t s e l f the researchers gained the impression that families found i n t e r -views threatening during the i n i t i a l stages. Possibly t h i s form of treatment c o n f l i c t s with an. interviewee set; or - 1 1 7 -possibly I n s u f f i c i e n t preparation and orientation ,1s provided the families by the therapists. Some of the families commented on the personality of the therapist, but no conclusion could be drawn from complaints here. I t i s conceivable that mechanism's of defense such as projections and r a t i o n a l i z a t i o n s were used. Nevertheless, the very presence of these comments by families leads the researchers to speculate that the presented personality of the therapist "may be a factor, e s p e c i a l l y i n the i n i t i a l stages of treatment. Technically, the researchers found that t h i s study r e l i e d too heavily on lmpresslonal ratings by the therapists and the families themselves. Too l i t t l e objective confirma-t i o n and v a l i d a t i o n was included i n the data. The higher number of families who refused to be interviewed suggests that this sample was not representative of the t o t a l pop-u l a t i o n of families who underwent treatment. However, the researchers f e e l the sample was nonetheless fundamentally s i m i l i a r enough to the t o t a l population, that generalization could be.made on a hypothetical basis. It was the impression of the therapists, that the sample used did not become "loaded" with any one type of family treated. It appeared as i f the stigma of "mental c l i n i c " , and "mental disease" was the prime motivating factor for families i n refusing to •be interviewed by the researchers. Recommendations. It i s because of the exploratory nature of t h i s study that very few recommendations could be made on the basis of our findings, with regard to p o l i c y , administration, or -118-t r e a t m e n t p r a c t i s e . However, t h e r e a r e i n d i c a t i o n s t h a t c e r t a i n p o s i t i v e changes c o u l d be made i n t h e i n t a k e p r o c e s s . The p o o r r e s u l t s a c h i e v e d w i t h f a m i l i e s a t t e n d i n g l e s s t h a n f o u r i n t e r v i e w s s u g g e s t s t o t h e r e s e a r c h e r s t h a t c a s e s r e f e r r e d f o r f a m i l y g r o u p t h e r a p y s h o u l d be done u n d e r t h e s t i p u l a t i o n t h a t t h e f a m i l i e s a g r e e t o a t t e n d a t l e a s t f o u r I n t e r v i e w s . T h i s w o u l d e s t a b l i s h a c o n t a c t i n t h e t r e a t m e n t p r o c e s s , a n d a l l o w t h e t h e r a p i s t s maximum use o f t h e i r t i m e i n p r a c t i s e . F u r t h e r , i t i s f e l t t h a t i t w o u l d be a d v i s a b l e f o r t h e t h e r a p i s t s t o p r o v i d e a g r e a t e r amount o f o r i e n t a t i o n t o t h e f a m i l y w i t h r e g a r d t o t r e a t m e n t ^ during.. t h e i . . i n i t i a l i n t e r v i e w s . S e v e r a l r e c o m m e n d a t i o n s a t t h i s s t a g e c a n be made w i t h r e g a r d t o f u r t h e r r e s e a r c h . I t i s f e l t b y t h e r e s e a r c h e r s t h a t a d d i t i o n a l s t u d i e s a r e needed on a n e x p l o r a t o r y b a s i s . S h o u l d t h e s e s t u d i e s be i n i t i a t e d , numerous improvements c o u l d be made o v e r t h e p r e s e n t p r o j e c t . F i r s t l y , i t may be u s e f u l t o p r e p a r e f a m i l i e s a t t i m e o f t r e a t m e n t f o r f u t u r e c o n t a c t by i n t e r v i e w e r s g a t h e r i n g f o l l o w - u p data... T h i s may r e d u c e t h e number o f f a m i l i e s r e j e c t i n g f o l l o w - u p c o n t a c t . S e c o n d l y , i t w o u l d be u s e f u l . t o g a t h e r i n f o r m a t i o n , s i m i l a r t o t h a t g a i n e d on t h e i n t e r v i e w s c h e d u l e , a t t h e o n s e t o f t r e a t m e n t . T h i s w o u l d a l l o w a b a s i s f o r c o m p a r i s o n o f p r e s e n t f u n c t i o n i n g a t t i m e o f t r e a t m e n t and f o l l o w - u p , making t h e d a t a more r e l i a b l e i n t h a t i t w o u l d n o t depend e x c l u s i v e l y on s u b j e c t i v e i m p r e s s i o n s o f change a s does t h e p r e s e n t s t u d y . T h i r d l y , g r e a t e r v a l i d a t i o n c o u l d be a c h i e v e d i f i n f o r m a t i o n c o u l d be g a i n e d f r o m e x t e r n a l s o u r c e s . F o r example, t h e r e s e a r c h e r s w o u l d have i n c l u d e d r e p o r t s f r o m -119-s c h o o l a u t h o r i t i e s on t h e f u n c t i o n i n g o f c l i e n t s a t s c h o o l b u t t h e t i m e a l l o w e d f o r t h e p r o j e c t was t o o l i m i t e d t o a l l o w f o r t h i s . F u r t h e r e x t e r n a l i n f o r m a t i o n c o u l d a l s o be o b t a i n e d f r o m o t h e r s o c i a l a g e n c i e s i n v o l v e d . • I f a f u t u r e s t u d y were t o be c o n d u c t e d a l o n g t h e same l i n e s a s t h e p r e s e n t s t u d y , s e v e r a l c h a n g e s c o u l d be made i n f o c u s , The r e s e a r c h e r s f e e l t h a t more a t t e n t i o n s h o u l d be made t o g a i n i n f o r m a t i o n d e a l i n g d i r e c t l y w i t h t h e symptoms o f t h e I.P. I n a d d i t i o n , i t may a l s o be u s e f u l t o a n a l y z e more t h o r o u g h l y f a c t o r s r e l a t e d t o f a m i l y s t r u c t u r e . T h e s e f a c t o r s c o u l d i n c l u d e a b s o l u t e s i z e o f f a m i l y , number o f f a m i l y members i n t r e a t m e n t , age r a n g e s , m i s s i n g p a r e n t s , s u r r o g a t e p a r e n t s , and so on. F u t u r e s t u d i e s o f t h i s t y p e c o u l d be made more l o n g -i t u d i n a l , i n v o l v i n g f o l l o w - u p c o n t a c t s a t i n t e r v a l s p r o t r a c t e d o v e r a g r e a t e r t i m e s p a n . E v a l u a t i v e s t u d i e s may g a i n b r o a d e r v a l i d i t y w i t h t h e u s e o f c o n t r o l g r o u p s ( e i t h e r c o m p a r a t i v e f a m i l i e s u n d e r g o i n g d i f f e r e n t f orms o f t r e a t m e n t o r f a m i l i e s n o t r e c e i v i n g t r e a t m e n t ) . I f l a r g e r s a m p l e s c a n be u s e d , u s e f u l i n f o r m a t i o n may be o b t a i n e d f r o m t h e u s e o f i n t e r -c o r r e l a t i o n s b e t w e e n r e p r e s e n t a t i v e c h a r a c t e r i s t i c s o f f a m i l i e s , s u c h as c l a s s , f a m i l y t y p e s , f a m i l y s t r u c t u r e , and symptom f o r m a t i o n . Hence, s t u d i e s c o u l d be made more d e s c r i p t i v e and more c o n d u c i v e t o s t a t i s t i c a l a n a l y s i s . As s t a t e d i n the p r e v i o u s s e c t i o n , more knowledge w o u l d be u s e f u l i n r e f i n i n g d i f f e r e n t i a l d i a g n o s i s and t r e a t m e n t method. D i a g n o s t i c t e s t s c o u l d be s t a n d a r d i z e d f o r use i n t h e a s s e s s m e n t p h a s e o f t r e a t m e n t . S u c h t e s t s c o u l d -120-be i n t e r a c t i o n a l analyses i n problem-solving tasks, Thermatic Apperception Tests, Rorschach tests, and so f o r t h . The focus for these could be on modes of communication and int e r a c t i o n patterns within the family ( i n the opinions of the researchers), much in the same manner as are now used by S a t i r . 1 Here too, c r i t e r i a f o r termination of treat-ment may be evolved. Knowledge gleaned from studies i n th i s area would help the development of appropriate use of d i f f e r e n t i a l treatment techniques as applied to s p e c i f i c family c o n s t e l l a t i o n s . At the same time various combinations of therapy could be studied to f i n d r e l a t i v e effectiveness of supplementary treatments i n conjunction with family group therapy. The l a t t e r may be able to overcome the suggested d i f f i c u l t y with lower class f a m i l i e s , families with disrupted structure, and families with c e r t a i n un-favourable i n t e r a c t i o n patterns. F i n a l l y , the study of the therapists' personality, or at least the manner i n which he interacts with s p e c i f i c family types may be usefu l i n establishing intake c r i t e r i a f or a l l o c a t i o n of cases, i n selection of candidates' for t r a i n i n g , and i n practise content of t r a i n i n g programs. ""Ssatir, V i r g i n i a . S a t i r ' s technique of formal intake diagnostic interview, now i n the developmental stage, Mental Research I n s t i t u t e , Palo Alto, C a l i f o r n i a * -121-ANNOTATED BIBLIOGRAPHY B a r d i l l , D o n a l d R. " F a m i l y T h e r a p y i n An Army M e n t a l H y g i e n e C l i n i c . " S o c i a l Casework, O c t o b e r , 1963. S e t i n a m i l i t a r y h o s p i t a l d e a l i n g m a i n l y w i t h p r o b l e m s o f a d o l e s c e n t d e p e n d e n t s o f m i l i t a r y p e r s o n n e l . O u t l i n e s f i r s t some a d v a n t a g e s o f f a m i l y g r o u p t h e r a p y , e . g . t i m e and p e r s o n n e l s a v i n g . E m p l o y s N a t h a n Ackerman's a i m s . Some d i s c u s s i o n o f t e c h n i q u e s f o l l o w s e m p h a s i z i n g t h e i m p o r t a n c e o f n o t d e v i a t i n g f r o m t h e f a m i l y u n i t . S c h e r z , F r a n c e s H. " M u l t i p l e - C l i e n t I n t e r v i e w i n g : T r e a t -ment I m p l i c a t i o n s , " S o c i a l Casework. V o l . X L I I I , 1963. Once a g a i n o u t l i n e s a d v a n t a g e s o f f a m i l y g r o u p t h e r a p y . Goes on t o d i s c u s s t y p e s o f f a m i l i e s a b l e t o u s e f a m i l y g r o u p t h e r a p y . 1. " e f f e c t i v e i n t h e t r e a t m e n t o f p e r s o n s w i t h a c t i n g o u t c h a r a c t e r d i s o r d e r s when t h e i r c e n t r a l p r o b l e m i s d i f f i c u l t y i n a m a r i t a l o r p a r e n t c h i l d r e l a t i o n s h i p and when t h e f i r s t g o a l o f b e h a v i o u r i s t o h e l p them examine t h e i r r o l e b e h a v i o u r " . 2 . " n e u r o t i c p a r e n t s o f p h o b i c c h i l d r e n " . 3 . " c h r o n i c i l l n e s s i s m a i n p r o b l e m " . 4. "when f i r s t t r e a t m e n t a i m i s t o improve r o l e f u n c t i o n i n g " . 5. " i n d i v i d u a l s who a r e t o o t h r e a t e n e d t o examine t h e i r own p e r s o n a l p r o b l e m s " . C o n t r a i n d i c a t I o n s 1 1. when f a m i l y r e c e i v e s g r a t i f i c a t i o n f r o m s u p p o r t i n g p a t h o l o g s . 2 . when t h e n e u r o s i s or c h a r a c t e r d i s o r d e r of one member i s c a u s e of o t h e r members d i s t u r b a n c e . 3 . overwhelmed by a n x i e t y . . . u n a b l e t o p a r t i c i p a t e . 4. when t h e r e i s a n e e d t o s e c u r e h i s t o r i a l d a t a . D i s c u s s i o n o f C o n c u r r e n t I n d i v i d u a l and Group T r e a t m e n t , e. g . when s t r o n g d e p endency n e e d s must be met. Some d i s c u s s i o n o f t e c h n i q u e s : 1. any I n t e r v e n t i o n s h o u l d be done i n terms o f f a m i l y i n t e r a c t i o n . 2 . w o r k e r s h o u l d m a i n t a i n e m p h a t i c n e u t r a l i t y . -122-3 . r e q u i r e s a l l members t o p a r t i c i p a t e by a p p r o p r i a t e i n t e r v e n t i o n . 4 . a t t e n t i o n t o n o n - v e r b a l communication. 5 . a l e r t t o f a m i l i e s g r o w i n g dependence on each o t h e r and n o t t h e r a p i s t . More u s e f u l a r t i c l e than, the average f o r our p u r p o s e s . Coyle„ Grace Longwel. "Concepts R e l e v a n t t o H e l p i n g the F a m i l y as a Group." S o c i a l Casework. V o l . X L I I I , 1963. D i s c u s s i o n of g e n e r i c c o n c e p t s from group w o r k e r s . Emphasis on F a m i l y R e l a t i o n s h i p s — s i g n i f i -cance of f a m i l y r e l a t i o n s h i p s s t r e s s e d . I n c o r p o r a t i o n of S o c i a l S c i e n c e c o n c e p t s d i s c u s s e d — - p a r t i c u l a r l y s o c i a l r o l e . A l s o a c o n s i d e r a t i o n of the f a m i l y w i t h i n i t s c u l t u r e . D i s c u s s i o n of s m a l l group t h e o r y and t h e r e a c t i o n of a f a m i l y as a group. Framework f o r U n d e r s t a n d i n g Group P r o c e s s e s . 1. the e s t a b l i s h m e n t of group i d e n t i t y e.g. common g o a l s ; overt,. I m p l i c i t ; , u n c o n s c i o u s D e t e r m i n a t i o n of membership, i n l t i t a l type of s t r u c t u r e . 2 c I n t e r p e r s o n a l R e l a t i o n s o r I n t e r a c t i o n a) s t a t u s o r r a n k i n g p r o c e s s b) sub groups c) r o l e s t r u c t u r e 3 . Group C o n t r o l and the E x e r c i s e of A u t h o r i t y . 4 . Group t h i n k as a B a s i s f o r A c t i o n as a Group, b a s i s , s t e p s i s d e c i s i o n making. a) becoming aware of problem b) c l a r i f y i n g and e v a l u a t i n g proposed s o l u t i o n s c) r e a c h i n g a d e c i s i o n a) a c t i n g upon the d e c i s i o n 5 . E m o t i o n a l a s p e c t s o f group b e h a v i o u r , m o r a l e , e t c . 6. t a l u e System o r Group C u l t u r e , (1) b e l i e f s c o n c e r n i n g r i g h t and wrong. ( 2 ) a p p r e c i a t e o r a e s t h e t i c v a l u e s — c o n c e r n i n g what i s c o n s i d e r e d a p p r o p r i a t e o r b e a u t i f u l . (3) c u l t u r a l v a l u e s . Summary - d i s c u s s i o n of t h o u g h t f u l use of t h e o r e t i c a l frameworks and co n c e p t s i n g e n e r a l . A d e s c r i p t i v e b u t u s e f u l a r t i c l e f o r out s t u d y . P o l l a k , O t t o and B r i e l a n d , Donald. "The Midwest Seminar on F a m i l y D i a g n o s i s and Treatment." S o c i a l Casework. V o l . XLII,~196i. A t t e m p t i n g t o f o c u s on d a t a t h a t w i l l h e l p i d e n t i f y the f a m i l y ' s most burdensome problem -123-c o n s t e l l a t i o n and the way I t a f f e c t s the f a m i l y . 1. what i s the most burdensome problem? 2. d e f e c i t or excess In f a m i l y membership. 3. i s the i n t e r a c t i o n problem mutually harmful. 4. e x t e r n a l pressures? 5. i n t e r n a l pressures of one partner? 6. i n view of the causative f a c t o r s , how can . t h e caseworker help the member's of the famil y group to change. Must take i n t o account i n d i a g n o s i s — f a m i l y sub-systems, s u b - c u l t u r a l s e t t i n g . Focus on the fa m i l y as a treatment u n i t from worker outside the f a m i l y . Some d i s c u s s i o n of s p e c i a l problems: 1. transference and counter t r a n s f e r e n c e . 2. i n t e r a c t i o n a n a l y s i s (establishment of lc n g and short term g o a l s ) . F a i r l y good d e s c r i p t i v e a r t i c l e but covering much the same po i n t s as d i d the Grace Coyle a r t i c l e . and therefore not of too much value f o r our study. M i t c h e l l , C e l i a B. " I n t e g r a t i v e Therapy of the Family U n i t . " S o c i a l Casework. February, 1965, V o l . XLVI, No. 2 . Describes the focus and very b r i e f t h e o r e t i c a l concept behind f a m i l y u n i t therapy at the Family Mental Health C l i n i c of the Jewish Family Service of New York. Suggests that the i n i t i a l response of the famil y i s one of the most important c r i t e r i a f o r p r e d i c t i n g success of f a m i l y group therapy. Suggests some f l e x i b i l i t y even a f t e r f a m i l y group therapy has been decided upon. Some problems i n v o l v e d i n f a m i l y therapy were mentioned: establishment of an a f f e c -t i v e bond; t h e r a p i s t s f e e l i n g of being an o u t s i d e r . Mentions some c o n t r a i n d i c a t i o n s to f a m i l y group therapy such as f i x e d pathology of any member; b a s i c dishonesty of parents, e t c . Not a p a r t i c u l a r l y u s e f u l a r t i c l e , competely d e s c r i p t i v e i n nature, adds nothing to knowledge on fa m i l y group therapy. Brandzel, E s t h e r . "Working through the Oedipal Struggle i n Family Unit Sessions." S o c i a l Casework. J u l y , 19&5, V o l . XLVI, No. ?. Takes place at the Family Mental Health C l i n i c of Jewish Family S e r v i c e . E n t i r e l y d e s c r i p t i v e a r t i c l e c o n c e n t r a t i n g almost e n t i r e l y on one f a m i l y case. -124-T h e h goes on t o d i s c u s s one c a s e i n d e t a i l . O f l i t t l e v a l u e . L i n d b e r g , R. D w a l r e and Wosmek, Anne W. "The Use o f Family-S e s s i o n s i n F o s t e r Home C a s e . " S o c i a l C a s e w o r k r M a r c h , 1963. T a k e s p l a c e i n a C h i l d C a r e Agency i n M i n n e a p o l i s . O u t l i n e s b r i e f l y some v a l u e s o f F a m i l y S e s s i o n s f o r f o s t e r f a m i l i e s " e a c h f a m i l y member i s h e l p e d t o r e c o g n i z e t h e i m p o r t a n c e o f h i s p a r t i c u l a r c o n t r i b u t i o n t o t h e s u c c e s s o f t h e c h i l d ' s p l a c e m e n t " . O u t l i n e s one c a s e h i s t o r y f o l l o w i n g v e r y b r i e f c o n c e p t u a l . i n t r o d u c t i o n . Not v e r y a p p l i c a b l e . B a r d i l l , D o n a l d R. and B e v i l a c q u e , J o s e p h J . " F a m i l y I n t e r -v i e w i n g by Two C a s e w o r k e r s . " S o c i a l Casework. May, 1964, V o l . XLV, No. 5. T h i s a r t i c l e i s t o t a l l y d e s c r i p t i v e . I t o u t l i n e s v e r y b r i e f l y some o f t h e t h e o r e t i c a l c o n c e p t s b e h i n d t h e c h o i c e o f two c a s e w o r k e r i n t e r v i e w s and t h e n g o e s on t o d i s c u s s t h e method u s e d . T h i s i s n o t a p a r t i c u l -a r l y u s e f u l a r t i c l e a s i t i s v e r y b r o a d a n d g e n e r a l and adds n o t h i n g new. -125-BIBLIOGBAPHY Ackerman, N. W.. The Psychodynamlcs of Family L i f e . Basic Books, New York; 1958. A l l p o r t , G. W. Pattern. Growth, and Personality. Holt, Rinehart, and Winston, New York; 196l. Axelrod, M. "Urban Structure and S o c i a l P a r t i c i p a t i o n " , American S o c i o l o g i c a l Review. Volume XXI, No. I. February, 1956. Beatman, F. L., Sherman, S. N., and Leader, A. L. "Current Issues i n Family Treatment", S o c i a l Casework. Vol. XLVII, No. 2, February, 1966. B e l l , J . E. "A Theoretical P o s i t i o n for Family Group Therapy". Family Process. Vol. I I , No. 1, March, 1963. . Family Group Therapy. Public Health Monograph No. 64, U.S. P r i n t i n g O f f i c e , 1961. , "Recent Advance i n Family Group Therapy", Journal of Child Psychology and Psychiatry. Vol. I l l , 1962. . "The Family Group Therapist: An Agent of Change", The International Journal of Group Psychotherapy, Vol. XV, No. 1, January, 1964. : B e l l , N. W., and.Vogel, E. F. The Family. The !Free Press of Glencoe, I l l i n o i s ; i960. Bendix, R., and Llpset, S. M. Class. Status, and Power. The Free Press of Glencoe, I l l i n o i s ; 1953. Bryenton, J . G. "Communication with Children", Master of So c i a l Work Thesis, University of- B r i t i s h Columbia School of S o c i a l Work, 1954. Cherry, C. "On Human Communication". A Review. A Survey, and  a C r i t i c i s m . Science E d i t i o n s , New York; I96I. Goode, W. J . The Family. Prentice-Hall, Englewood, New Jersey; 1964. . , and Hatt, P. K. Methods In S o c i a l Research, McGraw-Hill'Book Co., Inc., Toronto; 1952. Greene, B. L. (ed.) The Psychotheraples of M a r i t a l  Disharmony. The Free Press, New York; 1965. Hayley, Jay. "Research on Family Patterns: An Instrument Measurement". Family Process. Vol. I l l , No. 1, March, 1965. -126-. "Whither Family Therapy", Family Process. Vol. I, No. 1, March, 1962. Kahn, A. J . (ed.) Issues i n American S o c i a l WorkT Columbia University Press, New York; 1959. Kaplan, S. S., and Roman, M. Phases of Development i n Family Group Therapy. Unpublished Paper, Presented at Annual Conference, American Group Psychotherapy Association; January, I965. Lazarsfeld, P. F. The Language of S o c i a l Research. Free Press, Glencoe, I l l i n o i s ; , , 1955. . ^>N^<:>-N-^-,-Maas, H. S t r e s s f u l Situations and the Concept of Role Expectation. Unpublished Paper, Berkeley, C a l i f o r n i a ; No Date. „ Parad, H., arid M i l l e r , R. Ego-Oriented Casework; Problems and  Perspectives. Family Service Association of America, New York; 1963. Polansky, N. A. (ed.) S o c i a l Work Research. University of Chicago Press, Chicago; i960. Rabkin, L. Y. "The Patient's Family Patterns: Research Methods", Family Process. Vol. IV, No. 1, March, 1965. Relss, A. J . J r . , Occupations and S o c i a l Status] The Free 'Press of Glencoe, I l l i n o i s ; 1965. r Reusch, J . , and Kees, W. Nonverbal Communication: Notes on  the V i s u a l Perception of Human Relations t University of C a l i f o r n i a Press, Berkeley; 1964. ~ . Therapeutic Communication, W. W. Norton and Co., ' New York; 1961. " S a t i r , V. Conjoint Family Therapy. Science and Behaviour Books, Inc., Palo Alto. C a l i f o r n i a ; 1964. Shanas, E., and S t r e i t s , G. F. (ed.) S o c i a l Structure and  the Family. Prentice-Hall, New Jersey; 1965. "~ • Sherman, M.., et. a l . "Non-Verbal Communication i n Family Therapy", Family Process. March, 1965. 1 Steinhauer, P. D. Family Therapy: What i t Is and What i t i s  not. Unpublished Paper, Presented at Canadian Psy c h i a t r i c Association Annual Meeting, June, 1964. Watzlawick, P. An Anthology of Human Communication. Palo Alto Medical Research Foundation, Palo A l t a , C a l i f o r n i a ; 1964. - 1 2 7 -Weakland, J . H. "Family Therapy as a Research Arena", Family Process. V o l . I , No- 1, March, I962. W i l l i a m s , R. M.. Jr.., American S o c i e t y . A l f r e d A. Knopf, New York; 1951 . -128-APPENDIX I Introductory Letter to Prospective Interviewees Mental Health Centre, Dear The M e n t a l H e a l t h C e n t r e I s I n t e r e s t e d I n a s s e s s i n g I t s program i n o r d e r t o Improve and d e v e l o p s e r v i c e s t o f a m i l i e s . T h i s means r e s e a r c h i n t o the problems and u s e -f u l n e s s o f s e r v i c e s t o d i f f e r e n t f a m i l i e s and we a r e r e q u e s t i n g your a s s i s t a n c e i n a s s e s s i n g t h i s from y o u r p o i n t of v i e w . I t r e q u i r e s a meetin g w i t h f a m i l i e s w hich w i l l be e n t i r e l y c o n f i d e n t i a l and the d a t a o b t a i n e d would i n no way i d e n t i f y any p e r s o n or f a m i l y group. T h i s r e s e a r c h i s b e i n g done i n c o n j u n c t i o n w i t h the U n i v e r s i t y and i n v o l v e s a s o c i a l w o r k e r who has been a s s o c i a t e d w i t h the s t a f f of t h i s c l i n i c . I f t h i s i s a c c e p t a b l e t o you t h i s s o c i a l worker w i l l be c a l l i n g w i t h i n the n e x t few days t o a r r a n g e a meeting a t your c o n v e n i e n c e . S i n c e the a s p e c t which we a r e a s s e s s i n g i s F a m i l y Group Therapy we would w i s h such a meeting t o be w i t h the f a m i l y group. I n o r d e r t o take up l e s s of your time the meeting c o u l d be i n y o u r home. S i n c e r e l y , K. J . D a v i e s , M. D. D i r e c t o r . APPENDIX I I The I n t e r v i e w S c h e d u l e O c c u p a t i o n and E d u c a t i o n . 1. Are you now working"? F M IP __. I f so, have you a c q u i r e d work s i n c e a t t e n d i n g F.G.T.? F M IP 2. Is the job you are now d o i n g , the same job a t w h i c h you were employed w h i l e a t t e n d i n g F.G.T.? F M IP . What changes have been i n employment s i n c e a t t e n d i n g F„G„T. (a) I n p l a c e of work? F M IP ; Tb) i n type of job? F M . IP ( c ) p r o m o t i o n s o r demotions? F M I P ; (d) m e r i t r a i s e s (as opposed t o g e n e r a l r a i s e s ) ? F M IP . _ j (e) a r e you p l a n n i n g or a n t i c i p a t i n g any changes i n one of the s e a r e a s i n the ne a r f u t u r e ? F M ~ IP . 3 . How do you l i k e the job you are now do i n g ? (a) do you l i k e t h i s type of work? F M IP __L_; (b) do you t h i n k the s a l a r y i s f a i r ? F M IP ( c ) do you f e e l you are p e r f o r m i n g y o u r work b e t t e r t h a n average? " F IP ; (d) average? F M IP _j (e) or . a r e you h a v i n g d i f f i c u l t i e s " ? F M IP . How do you f e e l you a r e g e t t i n g a l o n g with. your boss c r bo s s e s ? F M IP . How do you f e e l you a r e g e t t i n g a l o n g w i t h your f e l l o w employees'? F M IP . Have t h e r e been any changes i n thes e a r e a s s i n c e a t t e n d i n g F.G.T.? ( r e p e a t c a t e g o r i e s i f n e c e s s a r y ) . F _____ M IP _. 4. Have you e n t e r e d any j o b t r a i n i n g o r e d u c a t i o n programs s i n c e a t t e n d i n g F.G.T.? F ___ M ___ IP . I f y e s , are t h e s e completed? F M IP i n c o m p l e t e d ? F M' _ IP . j p r o g r e s s ? F M IP . 5. In any t r a i n i n g o r e d u c a t i o n a l program i n w h i c h you are now i n v o l v e d ; how w e l l do you f e e l you a r e now p e r f o r m i n g the r e q u i r e d work? F M IP __ ; how do you enj o y the work? F _____ M ______ IP _____; how do you g e t a l o n g w i t h t e a c h e r s o r I n s t r u c t o r s ? F M . IP ; how do you get a l o n g w i t h o t h e r s t u d e n t s ? F M IP _. Have . t h e r e beer, any changes I n t h e s e a r e a s s i n c e a t t e n d -i n g F.G.T.? ( r e p e a t c a t e g o r i e s . i f n e c e s s a r y ) . F M • IP . 6. Are t h e r e any a d d i t i o n a l comments on any changes i n work o r s c h o o l s i n c e a t t e n d i n g F.G.T.? F M . IP . Do you f e e l t h a t any changes i n t h e s e a r e a s have been, brought about as a r e s u l t of f a m i l y group t h e r a p y . - 1 3 0 -R o l e P e r f o r m a n c e . 1. Who w o u l d you s a y makes t h e m a j o r d e c i s i o n s i n y o u r h o u s e -h o l d ? P _ M IP . 2 . A r e t h e r e c e r t a i n s i t u a t i o n s where e i t h e r mother o r f a t h e r makes t h e d e c i s i o n w i t h o u t c o n s u l t i n g e a c h other"? F _,. M IP _. C o u l d you p r o v i d e an example? (money, s e x , work, r e l i g i o n , p l a y , d i s c i p l i n e , h o u s e h o l d c h o r e s ) . P M * I P ~ . " 3 . Would you d e s c r i b e any changes s i n c e F.G.T.? F M _ IP _. 4 . A r e you more a c t i v e o r l e s s a c t i v e i n h o u s e h o l d d u t i e s s i n c e F.G.T.? P M IP _. 5. Do you e x p e c t d i f f e r e n t t h i n g s f r o m y o u r c h i l d r e n s i n c e P.G.T.? ( G i v e an e x a m p l e ) . P M . Do you e x p e c t d i f f e r e n t t h i n g s f r o m y o u r p a r e n t s s i n c e F.G.T.? ( G i v e an e x a m p l e ) . IP 6 . Do you a c c e p t y o u r p a r e n t s ' judgment on most d e c i s i o n s ? ( G i v e a n e x a m n l e ) . IP . D e s c r i b e any changes s i n c e • P.G.T. IP _ _ . 7 . Do o t h e r s i n t h e f a m i l y u s u a l l y l i s t e n t o y o u r i d e a s o r s u g g e s t i o n s ? ( G i v e a n e x a m p l e ) . I P . D e s c r i b e any changes s i n c e F . G . T . IP . 8 . M o t h e r : Have you f e e l i n g s a b o u t y o u r p l a c e i n t h e f a m i l y s i n c e F.G.T . ? Yes No . I f y e s , c o u l d you g i v e an example? . F a t h e r : Have you f e e l i n g s a b o u t y o u r p l a c e I n t h e f a m i l y s i n c e F . G . T . ? Yes No . I f y e s , c o u l d you g i v e a n example? . I . E . Have you f e e l i n g s a b o u t y o u r p l a c e i n t h e f a m i l y s i n c e F.G..T.? Yes . No I f y e s , c o u l d you g i v e a n example? Do you f e e l t h a t any c h a n g e s i n t h e s e a r e a s have b e e n b r o u g h t a b o u t as a r e s u l t o f f a m i l y g r o u p t h e r a p y ? F o r m a l Community R e s o u r c e s . 1. How do y o u f e e l a b o u t u s i n g s o c i a l a g e n c i e s i n y o u r community? P M IP . I f t h e above q u e s t i o n does n o t b r i n g o u t a t t i t u d e s a b o u t t h e M.H.C.,. say -How do you f e e l a b o u t t h e M.H.C. now t h a t you have had some c o n t a c t w i t h t h a t a g e n c y ? F M IP . D e s c r i b e a ny changes t h a t o c c u r r e d i n y o u r a t t i t u d e s a b o u t s o c i a l a g e n c i e s s i n c e F.G.T. F M IP 2 . Does r e l i g i o n p l a y an i m p o r t a n t p a r t I n y o u r f a m i l y l i f e ? F M _____ IP . D e s c r i b e a ny c h a n g e s t h a t may h a v e o c c u r r e d s i n c e P.G.T. F M IP . -131-3 . Do you belong to any organized groups or clubs i n your community? P M IP . Describe any changes i n your p a r t i c i p a t i o n since F.G.T. F M IP Do you f e e l that any changes i n these areas have been brought about as a r e s u l t of family group therapy? External Family Relationships and use of  Informal Community R e s o u r c e s . To Family. 1. Do you have any r e l a t i v e s i n the Vancouver or Lower Mainland area? Yes No . 2 . I f yes i n what way does the family keep i n touch with each other? By telephone V i s i t i n g each other's houses Combination of both Other . How often: Daily Weekly Monthly . I f no how often do you keep in contact with friends and neigh-bours? Explain how contact i s made and the frequency. 3 . Which side of the family do the members of t h i s family v i s i t or have contact with most often, the husband's side or the wife's side? . Can you explain the reason for t h i s ? . Describe any change i n the amount of v i s i t i n g or contact since F.G.T. . Which side of the friends do the members of t h i s family v i s i t or have contact with most often, the husband's side or the wife's side? . Can you explain the reason f o r t h i s ? . Describe any change i n the amount of v i s i t i n g or contact since F.G.T. 7 4 . Do the members of t h i s family use community resources such as neighbourhood playgrounds, community centres, night school courses, l i v i n g room learning courses, l i b r a r y , etc. P K IP . 5 . How often do you use these community resources, often, seldom, not at a l l . F M IP . 6 . Describe any change in the amount of the uses of these community resources since F.G.T. F M IP . 7. Do members of t h i s family want to j o i n other people ( r e l a t i v e s and/or friends) i n various a c t i v i t i e s . For example father and mother wanting to go out and do things with t h e i r r e l a t i v e s / o r friends, and the children wanting to do thinscs with t h e i r f r i e n d s . F M IP . 8. Describe any changes that have occurred since F.G.T. (Increase, about the same, or decrease, etc.) F M IP - 1 3 2 -Do you f e e l that any changes i n these areas have been brought about.as a r e s u l t of family group therapy.. Communication. Observe and make a b r i e f note at the end of this section on: 1. who usually speaks f i r s t 2 . what alignments take place 3 . i s there much laughter in the interview and i s i t appropriate. 1 . Can you usually understand what i s being said by family members during the family meetings'? F Yes No , M Yes . No , IP Yes No . Have there been any changes since F.G.T.? Yes No . If yes, can you give an example where the family shows added understanding? . 2 . Do you usually f e e l c e r t a i n that you know what another family member means? F Yes No , M Yes No , IP Yes No If- no, could you describe what i t was about his behaviour that.made you uncertain? (Probes) a) Did the words coming out of his mouth match the look on his face? F Yes No , M Yes : No . IP Yes •. No . b) Do you usually try to check out the meaning of what the other person says to you, to see i f that i s r e a l l y what was.meant by the message? F Yes No it M Yes No ,. IP Yes No . Describe any changes since therapy? . Is this change associated with anything that happened i n F.G.T.? ( I f yes, probe-for further d e t a i l s ) . 3 . How often do you get together to have family discussions? Once a week _ Twice a month Once a month Less Frequently . Describe any change since F.G.T.? 4 . Who would you say talks the most i n family discussions? F M. . IP . Describe any changes since F.G.T.? 5 . Do you think that your family usually gives you a chance to take part i n discussions? F Yes No , M Yes No , IP Yes No . Describe any changes since F.G.T.? __. 6 . How do you usually show other members of the family that you are happy or angry with them? (Please read a l l possible r e p l i e s to question before obtaining a r e p l y ) . - 1 3 3 -a) Do you t e l l them d i r e c t l y . F Happy Angry M Happy Angry IP Happy Angry b) Do you do things for them. F Happy Angry M Happy Angry IP Happy Angry c) Do you show them through d i r e c t physical contact. F Hugging and k i s s i n g Spanking and h i t t i n g M Hugging and Kissing Spanking and h i t t i n g IP Hugging and k i s s i n g Spanking and h i t t i n g d) Do you usually not say or do anything at a l l . F Happy Angry M Happy Angry IP Happy Angry . Describe any change since F.G.T. _. 7. Do family discussions usually end i n quarrels? Yes No If yes, could you describe what usually sets things off?. Describe any changes since F.G.T. 8. When you speak your mind or complain about a family member, how much consideration do you give to t h e i r feelings? . Father Mother I.P. A l o t ___ • • ' Some A l i t t l e . . None . _ Describe any changes since F.G.T.? 9 . When you express your feelings to family members, do you usually f e e l that they understand you"? F Yes No M Yes No _ _ IP Yes No . To Children: Do you f e e l that mother understands you more than father; or less than father; or about the same? •• Much More More Same '. Less Much Less Describe any change since F.G.T. . 1 0 . Have you noticed any change i n the time spent i n discussion of feelings of family members since F.G.T. Yes • No' . _.. If yes, when did you f i r s t notice a change? _ _ . How did you f i r s t recognize i t ? . Is t h i s change associated i n your mind with anything that happened in.F.G.T.? . I f yes, probe f o r further d e t a i l s ) . 1 1 . Do you l i s t e n to what other family members say to you? F Yes No M Yes No IP Yes No . Describe any change since F.G.T.? Is this change associated i n your mind with anything that happened in F.G.T.? ( I f yes, probe for further d e t a i l s ) . - 1 3 4 -I n t r a - F a m l l l a l R e l a t i o n s h i p s . P a r e n t s and C h i l d r e n . 1 . Do you t h i n k t h a t a s a f a m i l y you m a i n l y a g r e e , o r d i s a g r e e a b o u t most t h i n g s : F M IP . D e s c r i b e any changes s i n c e F T G . T . ? F M I P . 2 . When t h e r e a r e d i s a g r e e m e n t s , w h i c h f a m i l y members a r e t h e ones who d i s a g r e e most o f t e n ? F M IP . D e s c r i b e a n y changes s i n c e F . G . T . ? F M IP . 3 . When t h i n g s "go wrong" . i n t h e f a m i l y , d o e s some one f a m i l y member u s u a l l y g e t blamed? F M IP . D e s c r i b e any changes s i n c e F . G . T . ? F M I P . 4 . When t h i n g s . " g o wrong" i n t h e f a m i l y , w h i c h f a m i l y member(s u s u a l l y " s t i c k up" f o r e a c h o t h e r , o r "back t h e o t h e r p e r s o n up"? F M IP _. D e s c r i b e any changes s i n c e F . G . T . ? F M IP . P a r e n t s o n l y 5. Do you t h i n k you m a i n l y a g r e e , o r d i s a g r e e , upon t h i n g s t h a t a r e i m p o r t a n t t o you? F o r example: f e e l i n g s r e l a t e d t o s e x , management of.money, r a i s i n g t h e c h i l d r e n , r e l i g i o n o r any o t h e r i s s u e s w h i c h you f e e l a r e i m p o r t a n t . F M . D e s c r i b e any c h a n g e s s i n c e F.G.T.? F M , . 6. When t h e r e a r e d i s a g r e e m e n t s , c a n you d e s c r i b e what happens F o r e x a m p le: Does somebody l o s e h i s o r h e r temper, does somebody s t o p t a l k i n g , o r somebody " g i v e i n " , a r e t h i n g s " t a l k e d o u t " , o r does s o m e t h i n g e l s e happen? Can you d e s c r i b e what happens i n y o u r c a s e ? F M . D e s c r i b e any c h a n g e s w h i c h have o c c u r r e d s i n c e F.G.T.? F M . 7 . Do you t h i n k y o u r m a r r i a g e has t u r n e d o u t m a i n l y a s you had h oped i t would? F M . D e s c r i b e any changes i n y o u r t h i n k i n g a b o u t t h i s w h i c h have o c c u r r e d s i n c e F.G.T.? F M 8 . S i n c e a t t e n d i n g t h e M.H.C. f o r f a m i l y g r o u p t h e r a p y , do y o u f e e l y o u r s e x u a l r e l a t i o n s h i p i s : F more s a t i s f a c t o r y t h a n b e f o r e , t h e same as b e f o r e , l e s s s a t i s f a c t o r y t h a n b e f o r e . M more s a t i s f a c t o r y t h a n b e f o r e , t h e same as b e f o r e , l e s s s a t i s f a c t o r y t h a n b e f o r e . Do you f e e l t h a t any ch a n g e s i n t h e s e a r e a s have been b r o u g h t a b o u t a s a r e s u l t o f f a m i l y g r o u p t h e r a p y . - 1 3 5 -APPENDIX III L i c k e r t S c a l e o f T a s k S h a r i n g C o n j u g a l R o l e R e l a t i o n s h i p s - ( I d e a l  T a s k A l l o c a t i o n s ) . To be c o m p l e t e d s e p a r a t e l y by e a c h h u s b a n d and w i f e . 1. Y a r d work i s t h e man's j o b . and h i s w i f e s h o u l d n o t be e x p e c t e d t o h e l p w i t h i t . S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e . 2. U n l e s s i s a b s o l u t e l y n e c e s s a r y f o r t h e f a m i l y s u p p o r t , a w i f e s h o u l d n o t work. S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e . 3 . Housework i s f o r women. A man s h o u l d n o t do housework. S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e . 4 . A man s h o u l d s i m p l y " s t a y o u t o f t h e way" as f a r as housework i s c o n c e r n e d . S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e . 5- C e r t a i n f a m i l y t a s k s a r e "women's work" and o t h e r t a s k s a r e "men's work", and I t i s b e s t t o keep them s e p a r a t e . S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e . 6. A l t h o u g h f a t h e r s a r e c o n c e r n e d w i t h t h e i r c h i l d r e n ' s w e l f a r e , t h e r a i s i n g o f c h i l d r e n i s r e a l l y t h e m o t h e r ' s j o b . S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e . 7 . When t h e c h i l d r e n n e e d t o be p u n i s h e d o r s c o l d e d , t h e f a t h e r s h o u l d do i t . S t r o n g l y a g r e e A g r e e U n c e r t a i n , D i s a g r e e S t r o n g l y d i s a g r e e . 8 . When i t comes t o money m a t t e r s , what t h e man s a y s s h o u l d be t h e r u l e . S t r o n g l y a g r e e A g r e e U n c e r t a i n _____ D i s a g r e e S t r o n g l y d i s a g r e e . 9. A woman's p l a c e i s I n t h e home, n o t on a j o b . S t r o n g l y a g r e e A g r e e U n c e r t a i n D i s a g r e e S t r o n g l y d i s a g r e e _. Husband's P a r t i c i p a t i o n I n d e x . To be c o m p l e t e d s e p a r a t e l y by b o t h h u s b a n d and w i f e . Who does t h e f o l l o w i n g t a s k s i n the f a m i l y : 1. Washes and d r i e s t h e d i s h e s . W i f e a l w a y s W i f e -136-u s u a l l y U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s . 2 . Pays t h e m o n t h l y b i l l s . W i f e a l w a y s W i f e u s u a l l y _ U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s _. 3. Sweeps and s c r u b s t h e f l o o r s . W i f e a l w a y s W i f e u s u a l l y U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s . 4 . Does t h e g r o c e r y s h o p p i n g . W i f e a l w a y s W i f e u s u a l l y _ U s u a l l y done t o g e t h e r Sometimes one. sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s . 5. Makes t h e beds on weekends. W i f e a l w a y s W i f e u s u a l l y U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y H u s b a n d a l w a y s _. 6. D u s t s t h e f u r n i t u r e . W i f e a l w a y s W i f e u s u a l l y U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s . 7 . Does m i n o r h o u s e h o l d r e p a i r s . W i f e a l w a y s W i f e u s u a l l y U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s . 8 . Hangs o u t t h e c l o t h e s t o d r y . W i f e a l w a y s W i f e usuall3/ U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s 9 . S e t s t h e t a b l e . W i f e a l w a y s W i f e u s u a l l y U s u a l l y done t o g e t h e r Sometimes one, sometimes t h e o t h e r Husband u s u a l l y Husband a l w a y s . -137-APPENDIX IV T h e r a p i s t s ' I m p r e s s i o n s F a m i l y A. 1 . F a m i l y T y p e : C o n s t r i c t e d . 2. D i a g n o s i s o f I,P. A d j u s t m e n t r e a c t i o n o f c h i l d h o o d w i t h h a b i t d i s t u r b a n c e . 3. Number o f i n t e r v i e w s : 13 4. A s s e s s m e n t of F a m i l y f u n c t i o n i n g . a) .Communications: M o d e r a t e l y i m p r o v e d . • b) R o l e s : M o d e r a t e l y i m p r o v e d . c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y improved.-d) Symptom R e l i e f : M o d e r a t e l y i m p r o v e d . F a m i l y B. 1. F a m i l y T y p e : C h a o t i c . 2. D i a g n o s i s o f I,P. P a s s i v e a g g r e s s i v e p e r s o n a l i t y . 3. Number o f i n t e r v i e w s : 8 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y i m p r o v e d . b) R o l e s : M o d e r a t e l y Improved. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y i m p r o v e d . d) Symptom R e l i e f : M o d e r a t e l y i m p r o v e d . F a m i l y C. 1. F a m i l y T y p e : C o n s t r i c t e d . 2. D i a g n o s i s o f I.P. P s y c h o n e u r o t i c a n x i e t y r e a c t i o n . 3. Number o f i n t e r v i e w s : 6 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y i m p r o v e d . b) R o l e s : M o d e r a t e l y i m p r o v e d . c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y i m p r o v e d . d) Symptom R e l i e f : M o d e r a t e l y i m p r o v e d . F a m i l y D. 1. F a m i l y T y p e : L e a d e r l e s s . 2. D i a g n o s i s o f I.P. P s y c h o n e u r o t i c b e h a v i o u r d i s o r d e r . 3. Number o f i n t e r v i e w s : 12 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y i m p r o v e d . b) R o l e s : M o d e r a t e l y i m p r o v e d . c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y i m p r o v e d . d) Symptom R e l i e f : M o d e r a t e l y Improved. -138-F a m l l y E . 1. F a m i l y T y p e : L e a d e r l e s s . 2. D i a g n o s i s o f I.P. P s y c h o n e u r o t i c a n x i e t y r e a c t i o n , 3 . Number o f i n t e r v i e w s : 13 4 . A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a ) C o m m u n i c a t i o n s : Same. b) R o l e s : Same. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : Same. d) Symptom R e l i e f : Same. F a m i l y F. 1. F a m i l y T y p e : C h a o t i c . 2. D i a g n o s i s o f I.P. P s y c h o n e u r o t i c d e p r e s s i v e r e a c t i o n . 3 . Number o f i n t e r v i e w s : 1 4 . A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : Improved. b) R o l e s : Improved. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : I m p roved. d) Symptom R e l i e f : M o d e r a t e l y Improved F a m i l y G. 1. F a m i l y T y p e : D i c t a t o r i a l . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f c h i l d h o o d . 3 . Number o f i n t e r v i e w s : 12 4 . A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : G r e a t l y Improved. b) R o l e s : G r e a t l y i m p r o v e d . c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : G r e a t l y Improved. d) Symptom R e l i e f : G r e a t l y i m p r o v e d . F a m i l y H. 1. F a m i l y T y p e : L e a d e r l e s s . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f c h i l d h o o d . 3 . Number o f i n t e r v i e w s : 15 4 . A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : G r e a t l y Improved. b) R o l e s : M o d e r a t e l y Improved. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y Improved. d) Symptom R e l i e f : G r e a t l y Improved. F a m i l y I . 1. F a m i l y T y p e : C h a o t i c . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f c h i l d h o o d . 3 . Number o f I n t e r v i e w s : 5 4 . A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y i m p r o v e d . b) R o l e s : M o d e r a t e l y improved,. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y i m p r o v e d , d-) .Symp.tom R e l i e f : M o d e r a t e l y Improved. -139-F a m l l y J . 1. F a m i l y T y p e : D i c t a t o r i a l . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f c h i l d h o o d . 3. Number o f i n t e r v i e w s : 1 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : Same b) R o l e s : Same c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : Same d) Symptom R e l i e f : M o d e r a t e l y Improved. F a m i l y K. 1. F a m i l y T y p e : L e a d e r l e s s . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f c h i l d h o o d , h a b i t d i s t u r b a n c e . 3. Number o f i n t e r v i e w s : 1 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . . a) C o m m u n i c a t i o n s : No improvement. b) R o l e s : No Improvement. c) I n t - r a - f a m i l i a l r e l a t i o n s h i p s : No improvement. d) Symptom R e l i e f : No improvement. F a m i l y L . 1. F a m i l y T y p e : L e a d e r l e s s . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f a d o l e s c e n c e . 3. Number o f i n t e r v i e w s : 8 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y i m p r o v e d . b) R o l e s : M o d e r a t e l y i m p r o v e d . c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y i m p r o v e d . d) Symptom R e l i e f : G r e a t l y i m p r o v e d . F a m i l y M. 1. F a m i l y T y p e : D i s c o n n e c t e d . 2. D i a g n o s i s o f I.P. A d j u s t m e n t r e a c t i o n o f a d o l e s c e n c e , c o n d u c t d i s t u r b a n c e . 3. Number o f i n t e r v i e w s : 6 4. A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y Improved. b) R o l e s : M o d e r a t e l y i m p r o v e d . c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y Improved. d) Symptom R e l i e f : M o d e r a t e l y i m p r o v e d . F a m i l y N. 1. F a m i l y T y p e : D i s c o n n e c t e d . 2. D i a g n o s i s o f I.P. S c h i z o i d P e r s o n a l i t y . 3. Number o f i n t e r v i e w s : 7 4f A s s e s s m e n t o f F a m i l y f u n c t i o n i n g . a) C o m m u n i c a t i o n s : M o d e r a t e l y i m p r o v e d . b) R o l e s : M o d e r a t e l y i m p r o v e d . c) I n t i j a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y i m p r o v e d . d) Symptom R e l i e f : M o d e r a t e l y i m p r o v e d . -140-F a r s l l y 0 . 1. F a m i l y Type: D i s c o n n e c t e d . 2. D i a g n o s i s of I.P. Adjustment r e a c t i o n of a d o l e s c e n c e under achievement a t s c h o o l . 3. Number of i n t e r v i e w s : 24 4. Assessment o f F a m i l y f u n c t i o n i n g . a) Communications: M o d e r a t e l y improved. b) R o l e s : Same c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : Same d) Symptom R e l i e f : M o d e r a t e l y improved. F a m i l y P. 1. F a m i l y Type: D i s c o n n e c t e d . 2. D i a g n o s i s o f I.P. Adjustment r e a c t i o n o f a d o l e s c e n c e . H a b i t d i s t u r b a n c e . 3. Number of i n t e r v i e w s : 20 4. Assessment of F a m i l y f u n c t i o n i n g . a) Communications: G r e a t l y improved, b j R o l e s : G r e a t l y Improved. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : G r e a t l y improved. d) Symptom R e l i e f : G r e a t l y improved. Family q. 1. F a m i l y Type: C o n s t r i c t e d . 2. D i a g n o s i s of I.P. S c h i z o i d p e r s o n a l i t y . 3. Number of i n t e r v i e w s s 1 4. Assessment of F a m i l y f u n c t i o n i n g . a) Communications: Same b) R o l e s : Same c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : Same d) Symptom R e l i e f : G r e a t l y improved. F a m i l y R. 1. F a m i l y Type; D i c t a t o r i a l . 2. D i a g n o s i s of I.P. S p e c i f i c l e a r n i n g d e f e c t . 3. Number o f i n t e r v i e w s : 7 4. Assessment of F a m i l y f u n c t i o n i n g . a) Communications: M o d e r a t e l y Improved. b) R o l e s : M o d e r a t e l y improved. c) I n t r a - f a m i l i a l r e l a t i o n s h i p s : M o d e r a t e l y improved. d) Symptom r e l i e f : M o d e r a t e l y improved. -141-APPENDIX V R e f u s a l s We were a b l e t o g a t h e r d a t a on e l e v e n f a m i l i e s , who-' r e f u s e d t o a l l o w us t o i n t e r v i e w them,from f i l e m a t e r i a l and t h e r a p i s t s 8 i m p r e s s i o n s . G e n e r a l Characteristics of t h e R e f u s a l s . The general c h a r a c t e r i s t i c s w e r e : s e v e n f a m i l i e s were c o n s i d e r e d improved and four u n i m p r o v e d ; o f t h e s e l a t t e r f o u r , three of them had three o r l e s s i n t e r v i e w s . The f a m i l y types, were; c o n s t r i c t e d , f o u r f a m i l i e s ; a f f e c t i o n -l e s s , f o u r families; leaderless, d i c t a t o r i a l and d i s c o n n e c t e d one f a m i l y e a c h . A t t i t u d e s , Expressed. Most o f the refusals i n r e f u s i n g t o be i n t e r v i e w e d e x p r e s s e d very negative a t t i t u d e s t o w a r d t h e a g e n c y . Some o f the reasons given were: the t h e r a p i s t s were n o t on t i m e ; t h e r a p i s t s interested o n l y i n s e x ; d i s i n t e r e s t e d ; g e n e r a l h o s t i l i t y ; children r e f u s e d ; i m p o s s i b l e t o g e t t h e f a m i l y t o g e t h e r . P l e a s e see table number 1, 2, a n d 3 f o r a c o m p a r i s o n o f r e f u s a l with interviewed f a m i l i e s . T a b l e 1. The number of i n t e r v i e w s p a r t i c i p a t e d i n by  families i n t e r v i e w e d i n o u r f o l l o w - u p interviews compared w i t h f a m i l i e s who refused to be i n t e r v i e w e d . No. of Interviews Refusals A c c e p t a n c e s 3 or less 4 (36.2$) 3 (17.6$) 4 or more 7 (63.8$) 14 (82.4$) Total 1 1 17 -142-T a b l e 2. The T h e r a p i s t s ' r a t i n g s o f t h e outcome o f  t h e r a p y i n c a s e s w h i c h s u b s e q u e n t l y  r e f u s e d compared w i t h t h o s e who  a c c e p t e d f o r a f o l l o w - u p I n t e r v i e w . T h e r a p i s t s R a t i n g s R e f u s a l s A c c e p t a n c e s no improvement h (36.2$) 2 (11.7$) improvement 7 (63 .8$) 15 ( 8 8 . 3 $ ) t o t a l . 11 1? T a b l e 3• T y p e s o f f a m i l i e s i n t e r v i e w e d i n f o l l o w - u p  as compared w i t h t h o s e who r e f u s e d t o be  i n t e r v i e w e d . T y p e s o f f a m i l i e s R e f u s a l s A c c e p t a n c e s c o n s t r i c t e d a f f e c t l o n l e s s l e a d e r l e s s d i c t a t o r i a l d i s c o n n e c t e d c h a o t i c 4 (36%) 4 (36$) 1 (9$) 1 (9$) 1 (9$) 0 3 (16.6$) 0 5 (27.7$) 3 (16.6$) 4 (22.2$) 3 (16.6$) T o t a l . 11 18 C o n c l u s i o n s drawn f r o m T a b l e s . On t h e b a s i s o f t h e p r e c e e d i n g t a b l e s t h e r e f u s a l s w o u l d seem t o d i f f e r f r o m t h e a c c e p t a n c e s i n the f o l l o w i n g ways; t h e r e were more r e f u s a l s w i t h t h r e e o r l e s s i n t e r v i e w s t h a n a c c e p t a n c e s , and f e w e r r e f u s a l s w i t h f o u r o r more i n t e r v i e w s t h a n a c c e p t a n c e s ; t h e t h e r a p i s t s r a t i n g s seemed t o have some r e l a t i o n s h i p t o t h e numbers i n e a c h g r o u p , t h e t h e r a p i s t s r a t e d f e w e r no i mprovements i n t h e a c c e p t a n c e s ; i n t h e d a t a on f a m i l y t y p e s i t would a p p e a r that', t h e r e were f e w e r l e a d e r l e s s , d i c t a t o r i a l and d i s c o n n e c t e d i n t h e r e f u s a l s t h a n i n t h e a c c e p t a n c e s . The f a m i l i e s t h a t were i n t e r v i e w e d were p r o b a b l y h i g h l y u n r e p r e s e n t a t i v e o f the t o t a l f a m i l i e s who were s e e n a t t h e M e n t a l H e a l t h C e n t r e f o r f a m i l y g r o u p t h e r a p y . The e l e v e n f a m i l i e s s t u d i e d h e r e a r e j u s t a sample o f t h e t h i r t y - s i x t o t a l t h a t we were u n a b l e t o i n t e r v i e w . However, e v e n among t h e s e e l e v e n t h e r e a r e c o n s i d e r a b l e d i f f e r e n c e s b e t w e e n t h o s e who were i n t e r v i e w e d a n d t h o s e who r e f u s e d t o b e i n t e r v i e w e d . - 1 4 3 -APPENDIX VI Family Types The following d e f i n i t i o n s of family types have been developed and u t i l i z e d by the treatment team at the Burnaby Mental Health Centre as conceptual guides for p r a c t i s e . Constricted Family. The children cannot speak f r e e l y i n t h i s type of family and the family finds d i f f i c u l t y i n t a l k i n g about or i d e n t i f y i n g family problems. Chaotic Family. The chaotic family i s characterized by noise and confusion. Members talk f r e e l y , and often simultaneously, but do not l i s t e n to one another. The major communica-ti o n problem i s an i n a b i l i t y to l i s t e n . D i c t a t o r i a l Family. In t h i s family type one member, usually the father, i s excessively authoritarian or bossy. Af fect l o n l e s s Family. The a f f e c t l o n l e s s family i s characterized by a lack of overt expression of a f f e c t i o n between the family members. There are often overt expressions of d i s l i k e . Disconnected Family. There i s a lack of family l o y a l t y and p r i d e , i n this type of family. One member's hurt i s often not f e l t by another, and family members tend to go t h e i r own separate ways. Leaderless Family. There i s no power of decision i n t h i s family type. The children seem to run the family. Delinquent Family. In this family type there i s an apparent lack of conventional values, frequently leading to d i f f i c u l t i e s with the community. A number of the family members are d e l -inquent or unsocialized. The multlproblem family i s in this group. 

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