Assessment
problem – for instance, its salience for all family
members, its meaning to them, their responses
to it, and their views on aspects of the problems
such as how and why it arose, and the effects it
is having upon the family.
•
Family structure, composition and organization:
Here, the therapist will try to elicit factors such
as who is in the family, the roles and responsi-
bilities adopted by various family members, and
how the family organizes and regulates itself. For
instance, do the parents form a dyadic subsystem
in which they are united in taking on the parent-
ing role, or is one parent more closely aligned
with other family members? Over time, how do
families accommodate to internal and external
forces that impact upon them? For example, all
families will need to adapt to developmental
child processes that lead the child from infancy
to adulthood. In response to these forces for
change, does the family reorganize itself in a
way that is adaptive or in a way that proves
maladaptive? Is the family organization stable
enough for the family to respond to crises with-
out fragmentation?
•
Family processes:
The therapist will want to elicit
the nature of reciprocal interactions and trans-
actions. That is, how family members respond to
each other and how interactions at one point in
time have influenced, or potentially will influ-
ence, subsequent interactions between them.
Sequences of interactions will give rise to rela-
tionship patterns that the therapist will be keen
to ascertain in so far as they are relevant to
specific outcomes of interest.
•
Patterns of communication:
Together, family
members construct an understanding of given
happenings. What are these co-constructed
understandings, and how do they influence
the ways in which families communicate
with each other? What is the affective tone
of interactions – how are families conveying
emotion and how are emotions influencing the
communications between them?
•
Biopsychological factors:
These factors have
been seen to be important in, for instance,
medical family therapy models where the rela-
tionship between medical health conditions and
psychosocial dimensions is explored – as, for
example, in diabetes, anorexia and asthma [7].
More recently, attention has been drawn
to emerging knowledge of brain chemistry,
neurology and genetic factors and how these
impact upon behaviour and emotions [8]. This
could lead the therapist to seek to ascertain, for
instance, if a child’s difficulties within the school
system are related to genetically influenced
developmental factors. One question for the
family therapist when biopsychosocial factors
are of particular relevance is how do they influ-
ence both individual and family functioning,
that is, what is the dynamic interrelationship
between biological, psychological and family or
social factors?
•
Relationship levels:
The focus here is on the
social relations within the family – what are the
subsystems within the larger family system, and
how do these function in such a way as to account
for variance between different families? These
subsystems may be formalized in some models
of therapy into, for instance, tracking consis-
tent patterns of behaviour that are displayed
or elicited between and from various combi-
nations of family members, ranging from the
individual level (‘actor’ effects), to the family
as a whole (the ‘group’ effect) [9]. To illustrate,
when examining the expression of affect within
the family, how warmth is consistently expressed
by a given family member constitutes an ‘actor’
effect, while the way in which one individual
in the family elicits warmth from other fam-
ily members would be regarded as a ‘partner’
effect [10].
Within such frameworks, information will be
elicited from family members through a series
of discussions between therapist and family. It is
not easy, therefore, to make a sharp distinction
between assessment and intervention as these dis-
cussions may, in themselves, begin to have an
impact upon family communication, organization
and relationship patterns.
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