2. Families As The Focus Of Assessment: Theoretical And Practical Issues

The role of early and concurrent family relationships in the etiology of individual development and psychopathology has received increased attention in both research and practice within psychology in recent decades. Although the importance of family relationships in shaping personality has always been central in psychology, it was assumed with psychoanalytic theory that these forces were internalized within the individual such that intrapsychic dynamics were the dominant forces controlling behavior. Consistent with the premises of the dynamic model, the individual was the focus of assessment, treatment, and research within the discipline of psychology. Several converging developments in the 1950s led clinicians to break with the individualistic premises of psychology to view behavior as meaningfully related to the social system in which it was embedded. Systems theory was readily embraced by many clinicians disenchanted with the efficacy of individual treatment approaches for problems which had roots in dysfunctional relationships. The paradigmatic shift to a systems conceptualization of individual pathology generated the development of theoretical conceptualizations and treatments that were distinctive from those developed for the individual. The family was the obvious target for systemic intervention as the social context with the earliest, most continuous, and most affect laden influence on individual behavior and development. Conceptually, interventions with the family system are unique in that they emphasize human behavior as it occurs within the relationship matrix of an active social system and acknowledge and integrate multiple sources of psychological influence (individual, relationship, family, social) within a single treatment approach (Bednar, Burlingame, & Masters, 1988). As noted by these family scholars the conceptual distinctions are far from trivial:They suggest the wisdom, if not the absolute necessity, of having the family therapies based on psychological and treatment principles (a) that reflect multiple levels of psychological influence, (b) with variables that can be conceptually defined and empirically measured, (c) that capture the essence of personal, interpersonal, group, and systemic influences within any active social system, (d) at higher than usual levels of psychological immediacy and intensity, (e) that are derived from methods of measurement and data analyses that can identify reciprocal influences among interacting variables, (f) that will eventually define and describe the principles that regulate human behavior in complex social systems .. .. Even the most seasoned researcher and practitioner should feel overwhelmed by the complexity of the phenomena we are discussing. (Bednar, Burlingame, & Masters, 1988, pp. 408-409) Despite the challenges presented by the systems perspective, it has had a dramatic influence on the conceptualization of models of family functioning and the related development of family assessment measures. A review of recent measures and methods of family assessment, for example, found all measures of the family unit to be considered by their authors to be consistent with the premises of systems theory (Grotevant & Carlson, 1989). The influence of systems theory has also been evident in recent research and conceptualization within developmental psychology (e.g., Ford & Lerner, 1992), suggesting a stronger impetus to construct measures and to determine analytic methods for evaluating the premises of systems theory. This chapter on family assessment, although acknowledging the input from diverse theoretical perspectives, will emphasize the family systems perspective because this premise underlies the development of the majority of current clinical models of family functioning and the operationalization of their constructs in measures (see Grotevant & Carlson, 1989, and Touliatos, Perlmutter, & Straus, 1990, for reviews). As will be evident in subsequent discussion, one\u27s theoretical orientation will strongly influence decisions about assessment of the family. The emphasis on systems theory as the underlying framework for family assessment in the present chapter is not intended to communicate that general systems theory is a valid, scientific theory of family relationships, or that it is the only valid theory. In fact, systems theory, which has provided such a useful paradigm for clinicians, has been criticized as overly holistic and anti analytic, with constructs that are difficult to operationalize, and a theory that is difficult to falsify (see Grotevant, 1989). Lending some validity to the antianalytic accusations, assessment has been viewed by many family clinicians with ambivalence. This has been due, in part, to the action orientation of family therapy which mediates against the systematic gathering of information to arrive at a diagnostic formulation (Karpel & Strauss, 1983). If one accepts the scientist practitioner model of psychology, however, which emphasizes the reciprocal value of scientific inquiry to accountable practice and the importance of clinical results to theory building, then the field is faced with either the falsification of systems theory as a model of family process or the reconciliation of systems theory in family assessment. Systems theory does, however, pose considerable challenge to family assessment. It is the purpose of this chapter to examine the theoretical and practical challenges inherent in assessment of the family as a system. The chapter will be organized commonly accepted steps of the assessment process:1. Define the purpose, objective, or research question. 2. Make theory or assumptions explicit. 3. Inventory instruments or resources. 4. Perform the assessment. 5. Analyze and interpret the data. Within the first step the differential goals of family assessment in research versus clinical practice will be discussed. In the second assessment step the links between theory and assessment will be discussed, and a brief review of the diverse theoretical influences on family assessment will be provided. An overview of methods of family assessment will next be provided (Step 3) followed by a discussion of the practical concerns in the selection and integration of family assessment measures and methods (Step 4). Finally, issues in the compilation and interpretation of family assessment data (Step 5) will be examined with particular attention to the use of statistical analytic techniques for resolving family assessment challenges