The Round-Robin Family Assessment with Social Relations Model Analysis

The approach to family assessment presented here is based on the notion that a family is a system of interdependent individuals. For many years family therapists, psychiatrists, clini­cal and developmental psychologists, and social workers have been advocating the view that individual behavior and functioning cannot be understood in isolation from the per­son’s primary social context, usually the family. However, because the family system is a complex organization, the methods for studying interdependence in family relationships are complex as well. Most family assessment instruments have tried to simplify the procedure, obscuring the systemic nature of family relationships in the process. In this chapter I pre­sent the Round-Robin Family Assessment with Social Relations Model analysis (RR-SRM), a quantitatively based method for assessing individual families that goes a long way toward revealing the complexity of family systems and how each family member fits within the com­plex whole (Cook & Kenny, 2004). I begin with a brief discussion of the theoretical frame­work that underlies the approach. This is followed by an extended presentation of the method and the type of information it provides. Finally, I present a case example of a family seek­ing treatment for an adolescent who is in the prodromal phase of psychosis. FAMILIES AS SYSTEMS

There are actually many different perspectives on what it means for a family to be a system, and different models of family therapy are loosely tied to these different conceptualizations. Struc­tural family therapy (Minuchin, 1974), for example, emphasizes the importance of bound­aries and structure within the system. When the boundary between the parent and child gener­ations gets either too rigid or too diffuse, the child may develop a problem. Thus, boundaries are defined in terms of patterns of interaction between family members; they are relational. The model of brief family therapy developed by the Palo Alto group (Watzlawick, Weakland, & Fisch, 1974) emphasizes the unhelpful feedback loop that exists when the solutions people 99

attempt exacerbate the problems they were intended to solve. For example, a father may lose his temper in a childish way while trying to get his child to be more responsible and adult­like. One thing that these and most other systems-oriented theories of family have in common is the idea that “a change in one part of the system is followed by compensatory change in other parts of the system” (Bowen, 1982, p. 154). However, whether or not a change in one person will elicit a change in another person depends on whether there is interdependence in the rela­tionship. Thus, interdependence is fundamental to any view of the family as a system. There is interdependence whenever what happens to one person matters (in a positive way or in a neg­ative way) to another person. Much of what happens to us on a day-to-day basis is routine and has no effect whatsoever on those around us. Interdependence is observable only when cer­tain thresholds are reached or when particularly significant events occur. Thus, the measure­ment of interdependence must be specific to particular variables within particular relationships.Some forms of interdependence can be described as instrumental. For example, if my wife wins the lottery, it will undoubtedly affect how I spend my time. Other forms of inter­dependence are emotional. For example, when a child becomes ill, family members become emotionally focused on and behaviorally organized around the child. Often the emotional and functional aspects of interdependence overlap. Not only do a child’s illness and distress elicit caretaking and nurturance from his or her parents, but a parent may have to miss work to stay home with the sick child, take the child to the doctor, or otherwise alter the plans for the day. A sibling may temporarily feel neglected because of the focus on the other child. When a parent is the one who becomes ill, the other parent may take on the chores that the ill par­ent normally performs, expanding his or her usual workload. In some cases, a child may take on adult responsibilities prematurely to compensate for a parent’s illness. If it is a chronic illness, the child may forfeit his or her childhood. The Individual within the System

In some respects, the ability to describe the organization of the family in terms of interper­sonal dynamics is a goal in its own right. Thus, it is reasonable to study family variables with­out a particular focus on the outcomes of any one family member. However, that was not the original goal when psychiatrists and other professionals first began describing families as systems (e.g., Ackerman, 1956; Bateson, Jackson, Haley, & Weakland, 1956; Bowen, Dysinger, Brodey, & Basamania, 1957; Bowlby, 1949). The goal then was to understand how family relationships were affecting the course of illness for psychiatric patients (mostly people with schizophrenia). The ideas that were generated by the early thinkers were so excit­ing that understanding the system often became all important and the individual became almost insignificant. In this chapter I take the view that the focus of a clinician should be primarily on the outcomes of the identified patient. However, the role of the family should be understood in terms of whether it contributes positively or negatively to the identified patient’s (IP’s) outcomes and whether the patient’s outcomes contribute positively or nega­tively to family members’ outcomes. More radical views of the role of the family in the devel­opment of a person’s psychological problems, such as the idea that having a member with a psychiatric illness somehow benefits (provides homeostatic balance to) certain types of families (Jackson, 1957), have not to my knowledge been supported empirically. The Assessment of Family Functioning

Historically, the most common way of assessing the family system quantitatively has been through the use of measures where an individual rates the family as a whole. The Family

Environment Scale (FES; Moos & Moos, 1981) and the Family Adaptability and Cohesion Scales (FACES IE; Olson, Portner, & Lavee, 1985) are well-known versions of whole-family assessments. An example of an item from such a scale is “People in my family look out for each other.” Such scales are problematic for a number of reasons (Cook & Kenny, 2005). First, each family member may have a different perspective on how the family is function­ing (Jacob & Windle, 1999). Because the perspective of the rater is confounded with the target of the rating (i.e., the family system), it is difficult to know in any given case whether an extreme score is due to characteristics of the rater or characteristics of the family. Thus, when the developers of these instruments report validity data showing that the instruments distinguish between clinical and nonclinical families, the differences could be due to rater effects, perhaps reflecting an individually based illness, or it could be because the families are actually different in some way (i.e., a target effect). Summing over the ratings of differ­ent family members to create an aggregate score, an attempted solution to this problem, is not adequate. Ratings from as many as seven different family members may be needed to can­cel out the effect of one extreme rater (Schwarz, Barton-Henry, & Pruzinsky, 1985).A second problem with whole-family ratings is that the target of the rating is not as obvi­ous as it might first seem. For example, if a teenage daughter does not get along with her mother, how should one rate the family as a whole? One family member may report that the family as a whole functions well, despite problems in one subsystem in the family. Another family member may believe that the mother-daughter dyad epitomizes the family as a whole, even though other relationships in the family are functioning well. Because the family is not a thing like a tree or a car, it cannot serve as an unambiguous target of an assessment rating. There are too many components of the system that might be differentially salient to different family raters. Because the items measuring whole family functioning have more than one possible meaning, methodologists call them double-barreled items (Judd, Smith, & Kidder, 1991). Such items should be avoided in the development of psychological or psy­chosocial measures.The third problem is a conceptual one. It has been said that the difference between a group of individuals and a family system is like the difference between a pile of bricks and a house. The number of bricks in a pile and the number used to make a house can be the same, but it is the architecture, the way the bricks fit together, that defines the house. The same is true for the family system. The patterns among the relationships, not the group size or group aver­age, define the proverbial “whole” that is greater than the sum of the parts. Ratings of dyadic and whole family functioning do not reveal the patterns in a family system, that is, how the individuals fit together. In this fundamental regard, measuring families at the group level dis­regards the defining features of the family system. I suspect that the idea that “the whole is greater than the sum of the parts” has been misunderstood by those who have developed mea­sures of whole-family functioning. Rather than a pattern, they have given us a pile.Finally, ratings of whole-family functioning assume that family members are similar to each other. Although there are aspects of the environment that family members do share (e.g., the size of the home, the neighborhood, income), family members do not share the same set of family relationships. For example, an overly rebellious child often has a conforming sib­ling in his or her environment, whereas an overly conforming sibling often lives with a rebel­lious sibling. A permissive parent often has to co-parent with someone he or she experi­ences as overly strict, whereas a strict parent often feels the need to compensate for the behavior of a permissive parent (Cook, 2001). The point is that family dynamics often make family members different as they compensate for the behaviors of each other. The existing measures of whole-family functioning do not measure or reveal such patterns.