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The International Journal of the Addictions, 27(10), 1187-1 196, 1992
Conscious and Unconscious Perceptions of Self in Children of Alcoholics* Paula Markowitz, Psy.D., and Robert J. Craig, Ph.D.+ Illinois School of Professional Psychology, Chicago, Illinois 60604
ABSTRACT The conscious and unconscious self-concept was examined in three groups of children: 23 children of alcoholics (COA), 19 children from nonalcoholic but dysfunctional families, and 23 children from normal families without alcoholism or family dysfunction. Self-concept was assessed both objectively, using the Piers-Harris Children's Self Concept Scale, and subjectively, using the Draw-A-Person Test and the Thematic Apperception Test from rating systems designed to tap unconscious dimensions of self. The COAs and normal controls were also compared for behavioral problems with the Achenbach Child Behavior Checklist. We found that COAs made more positive selfstatements on objective measures of self-concept than children from families without alcoholism, whether or not the families were dysfunctional. Subjective analyses of projective test responses revealed unconscious differences in self-concept among the COAs, though this was not corroborated with objective scores, probably due to the crudeness of the rating instrument in failing to tap these dimensions. Also
*This study was based, in part, on a dissertation completed at the Illinois School of Professional Psychology by P.M. under the supervision of R.J.C. 'Address reprint requests to Robert J . Craig, Ph.D., Illinois School of Professional Psychology, 220 S.State St., 5th Floor, Chicago, Illinois 60604. I187 Copyright 01992 by Marcel Dekker, Inc
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COAs had significantly more behavior problems, based on parental reports, which contrasts with their objective reports of self. Implications of these findings were discussed.
Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
INTRODUCTION There are an estimated 28 to 34 million children of alcoholics (COAs), including 12 to 15 million under the age of 18 who are currently living with at least one alcoholic parent (Edwards and Zander, 1985; Woodside, 1988). The literature documents a myriad of psychological and emotional problems extant in this “at risk” population (Black, 1979; Wegschedier-Cruise, 1976). Noted also is that the majority of these children are doing well, despite the “appearance of survival.” The literature suggests that when they reach adulthood, the apparent adaptive, successful, and positive response patterns that were functional in childhood become dysfunctional in adult roles. The central organizing concept that has guided much of this clinical theorizing has been the “self-concept,” “self-esteem,” or “self-perception.” Most clinical explanations of these adult troubles in COAs focus on the belief that the core sense of self is profoundly influenced by the character and degree of early parental relationships. In an alcoholic family, the abusive, nonemphathic, and exploitative aspects of family functioning become introjected into pathological patterns. What emerges are “roles,” variously reported as “hero,” “scapegoat,” “lost child,” “mascot,” “adjuster,” and “placator,” which seem functional and adaptive in childhood but which become maladaptive in adult roles. The original function of these roles, according to theorists, is to help the children cope successfully with the family’s problems and to reduce the emotional pain of growing up in an alcoholic home. Studies are only beginning to appear that assess the self-concept of COAs as compared to other groups. The majority of these studies found that the selfesteem scores of COAs are lower than those other groups (Baraga, 1978; Hughes, 1977; O’Gorman, 1975; Roosa et al., 1988) although Herjanic et al. (1978) found that inner city COAs had average to above average self-esteem scores on the Piers-Harris Self-concept Scale (PHSCS). The unusual aspect of such research is that it has focused entirely on conscious self-reports, whereas the clinical theory driving this research has placed major emphasis on the unconscious determinations affecting subsequent adult behaviors in this population. The purpose of this present study was to examine the self-esteem in children who have been raised in alcoholic homes compared to children who have grown up in distressed families with no alcohol problems and children from stable homes with no alcoholism. We use both objective and projective methods to compare the conscious and unconscious aspects of the self-concept in a COA group.
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SUBJECTS
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A total of 65 subjects was obtained for this study. Each subject volunteered for the study, and an informed consent was obtained from the parent or legal guardian.
Group 1. This group consisted of 23 children of alcoholics who had at least one alcoholic parent. These children were attending a COA suport group at a local alcohol treatment facility. The group consisted of 12 females and 11 males with a mean age of 10.7. Ten had alcoholic fathers, three had alcoholic mothers, and the remainder lived in homes where both parents were alcoholics. Seventeen were White, four Black, and two Hispanic. Group 2. Subjects in Group 2 consisted of 19 children who lived in a distressed home environment where families were dysfunctional in a variety of ways but did not have parental alcoholism. There were 13 females and 6 males with a mean age of 10.9. Ten were White, seven Black and two Hispanic. They were obtained through a major university’s department of child and adolescent psychiatry where they were receiving mental health services for problems related to school or behavior. No alcoholism was reported in these homes. Group 3. This group consisted of 23 children without evidence of academic or behavioral problems and who lived in homes without current or histories of parental alcoholism. There were 16 females and 7 males with a mean age of 10.5. Ten were White, seven Black, and six Hispanic. They were recruited through a local public elementary school. There were no significant differences in age between the three groups of children ( F = .39, P > . 0 5 ) .
INSTRUMENTS The Draw-A-Person (DAP) Test (Machover, 1949; Ogdon, 1967) and the Thematic Apperception Test (TAT) were used as measures of unconscious self-concept (Magrab, 1984; Murray, 1943). The Piers-Harris Children’s Self-concept Scale (Cosden, 1984; Hughes, 1984; Piers and Harris, 1969) was used to measure conscious self-concept. The Achenbach Child Behavior Checklist (CBCL) was used to measure behavior problems (Achenbach and McConaughy, 1987). On the DAP, self-esteem was assessed by the height of a human figure drawing in centimeters (Machover, 1949). On the TAT, we developed a scoring system to measure self-esteem, based on the empirical work of Fine (1951) and Klebenoff (1951), which required two trained raters to blindly assess each TAT story along the dimensions of feelings, outcomes, conjiict resolutions, and qualify of object relations. A qualitative analysis of the TAT stories was also performed to add richness and comprehensiveness to the results. This consisted
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of a detailed subjective analysis of each card with a focus on unconscious communications. The Piers-Harris test is objectively scored and provides a total score and six subscale scores dealing with various aspects of self. The CBCL is also objectively scored and provides quantitative data in nine behavior problem areas.
PROCEDURE Although identical procedures for participation would have been desirable, practical difficulties in obtaining these types of subjects made this impossible. Thus, it was necessary to sacrifice some methodological rigor in lieu of practicality. Children from alcoholic and normal populations were tested in small groups. Each subject was given a packet which included a blank piece of 8 % ' ' ~ll"paper, with the heading "Draw A Person," the PHSCS, and six TAT pictures with accompanying instructions as suggested by Murray (1943). Children were allowed to work through the packet at their own pace, and the senior author was available to help with individual questions. Subjects from distressed families were tested individually as part of a more comprehensive evaluation. Parents from the alcoholic and normal groups completed the CBCL either at the time of initial testing or at home. Although it would have been desirable to have parents of the disturbed controls complete this test as well, this instrument only became available to us later and after this group had already been tested. Table 1 presents an overview of the groups and tests administered.
RESULTS Quantitative
DAP. The dependent variable was the length of the human figure drawing in centimeters. An analysis of variance performed across all three groups found no significant differences in the length of drawings ( F = 2.10, P > .05). PHCSCS. First, a multivariate analysis of variance was performed across the seven scales (total score and six subscales) and was significant (Wilks' lambda p < .01). Next, an analysis of variance was conducted followed by planned comparison tests using Fisher's Least Significant Different Test (LSD). These results are presented in Table 2. Statistically significant differences occurred between groups on all scales except Intellectual and Social Status. Fisher's LSD test revealed that the COAs were significantly different
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PERCEPTIONS OF SELF IN CHILDREN OF ALCOHOLICS
Table 1. Group Demographics
Groups I
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Variables
I1
111
TY Pe
23 Children of Alcoholics
19 Children in nonalcoholic dysfunctional families
23 Normal children in nonalcoholic, nondysfunctional families
Mean age (years)
10.7
10.9
10.5
Males
11
6
7
Females
12
13
16
White
17
10
10
Black
4
I
I
2
2
6
Yes
Yes
Yes
Piers-Harris Children’s SelfConcept Scale
Yes
Yes
Yes
Thematic Apperception Test
Yes
Yes
Yes
Achenbach Child Behavior Checklist
Yes
No
Yes
N
Hispanic Instruments: Draw-A-Person Test
from the normal group in the areas of physical appearance and popularity and from the disturbed controls in behavior, anxiety, popularity, happiness and in overall self-concept scores. These results show that COAs made more positive self-statements than children from families without alcoholism, whether or not those families were dysfunctional. On a conscious level, the COAs demonstrated the highest self-esteem of all three groups.
TAT. Interrater reliability between the two raters averaged .85 across all scales for all 65 subjects. A multivariate ANOVA was then executed and was not significant (Wilks’ lambda p > .05). A subsequent univariate ANOVA was also performed, and only one of 16 possible variables reached significance-a result that was attributed to chance.
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Table 2.
Piers-Harris Children's Self-Concept Scale Scares between Groups
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~
~~
I KOA) Scales Total score Behavior Intellectual and Social Status Physical Appearance Anxiety Popularity Happiness and Satisfaction
M
SD
11
111
(BC)
(NORM)
M
SD
M
SD
F
P
58.8 52.3 55.6
8.33 8.88 7.76
51.9 46.1 50.7
10.21 8.15 10.33
54.6 53.9 52.9
7.06 7.74 8.74
3.31" 4.60a 1.55
.04
59.3 58.0 55.2 58.6
10.30 8.10 9.96 7.05
53.1 49.0 47.1 48.1
11.36 13.40
50.7 54.0 48.80 54.5
8.30 8.88 7.27 7.63
4.51" 3.85" 4.35" 7.19
.01
11.11
11.10
.01
.22
.02 .02 ,001
Statistically significant.
CBCL. A MANOVA was significant (Wilks' lambda p < .01) for the 15 scales of the CBCL. Each scale was then analzyed individually by using a univariate ANOVA. The results are presented in Table 3. Except for four subscales, the COAs exhibited significantly more behavioral problems than normal controls on all other subscales. Although the sample was small, we performed separate analysis by gender and race and found significant differences. Therefore, an analysis of covariance (ANCOVA) was performed controlling for the effects of gender and race, and the results remained essentially unchanged. After adjustment, the COAs differed from the disturbed control group on the additional variable of physical appearance (P< -03).Again, the COAs scored higher on this measure. To summarize, the COAs had the highest conscious self-esteem of all three groups on the PHSCS, but they also demonstrated significantly more behavior problems than children from normal families. Objective scoring systems applied to the TAT and DAP found no significant differences in unconscious self-esteem. Because of the difficulty in quantifying these unconscious processes, a clinical qualitative analysis was then conducted to tap this rich material. Qualitative Analysis
Although our rating system did not find any differences in unconscious self-perceptions between groups, we did notice some common themes in the
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PERCEPTIONS OF SELF IN CHILDREN OF ALCOHOLICS
Table 3. Behavior Checklist Scores
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Groups
I (CON Scales Total score Externalizing Internalizing Depression Social Withdrawal Somatic Complaints Hyperactive Delinquent Aggressive Schizoid Anxious Obsessive Compulsive Uncommunicative Schizoid Obsessive Sex Problems Cruelty
I1
(NORM)
M
SD
M
SD
F
P
66.4 65.0 65.3 67.6 65.7 61.1 64.7 68.9 66.0 63.5 63.3 71.2 63.4 61.5 64.3
10.29 10.38 10.13 9.57 7.80 6.10 10.40 8.11 11.39 7.63 10.72 12.90 6.99 8.73 9.33
49.7 50.5 49.6 56.0 57.3 58.2 55.9 59.9 56.6 55 .O 55.8 59.8 56.8 58.6 58.9
8.49 7.23 9.03 2.32 4.17 5.89 I .82 4.40 3.24 0 1.10 8.67 3.40 5.48 5.48
36.45a 29.67a 29.74a 30.85" 19.92" 2.52 15 .0ga 2 I .38' 13.91" 5.90" 2.33 3.17 1 I .44" 1.17 3.93
.OoO1 .OoO1
.OoOI .oO01
.OoOI .I2
.o004 .OoOI
.o006 .03
.I5 .I0
,002 .29 .06
Statistically significant
TAT stories of the COA group. We found that the COA stories contained themes and imagery where parental concern and attention were frequently absent. Rather than seeing parental figures as nurturing, parents were seen as hostile, destructive, and abandoning. The children often exhibited excessive self-reliance and feelings of responsibility to care for their distressed parents. At the same time they felt helpless, frightened, and confused. The most frequent image that occurred across all cards in the COA group was the devastating effects of drugs and alcohol on the family. The resulting feelings of anger, grief, and frustration invariably surfaced with characters using questionable ways to manage them. Substance abuse was described as leading to marital discord, leaving children abandoned, and disrupting childhood dreams. Violins, dolls, and other possessions were broken, children were portrayed as hungry orphans desperate to be fed and clothed, and young children were beaten, slapped, chased, and neglected. Likewise, there were descriptions of horrific car accidents, birds falling from trees, bears ripping little children apart, overworked slaves enduring a life of hard labor, and bursts
MARKOWITZ AND CRAIG
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of uncontrolled violence such as burning, smashing, stabbing, choking, ripping, slicing, and murdering. The basic feeling permeating the stories of the COAs was one of being neglected or forgotten by the parent.
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DISCUSSION Children of alcoholics (COAs) have been described as outwardly appearing happy, competent, and well-adjusted, but beneath this veneer they harbor unconscious negative self-perceptions and low self-esteem. We found that the conscious self-concepts of COAs actually were higher than those of the other two groups, and this finding appeared across almost all scales of the PiersHarris Children’s Self Concept Scale, while children from dysfunctional families without alcoholism scored lowest on self-esteem in all three groups. In contrast, we found no differences in self-concept between groups in their unconscious self-perceptions upon quantitative analysis. These findings appear surprising, perplexing, and somewhat contradictory. Particularly troublesome was the finding that COAs had the highest amount of self-esteem by self-report, especially when they came from families that the literature describes as characterized by parental instability, neglect, and emotional malnourishment. However, prior research with the PHSCS has also found contradictions concerning whether or not COAs have high or low selfesteem (Baraga, 1978; Herjanic et al., 1978; and O’Gorman, 1975). We believe that there is not one universal finding for COAs regarding high or low self-esteem. If one parent is able to provide a stable and nurturing relationship with the child, despite the presence of familial alcoholism in their spouse, then a positive self-concept is possible. Another explanation is that their high scores may reflect overcompensation as an adaptive behavior. This externally positive self-image may be a protective shield to defend against intense stress and intolerable feelings. Consider the additional finding that, despite their report of high selfesteem, the COAs had a high degree of behavioral difficulties on the CBCL. These included more problems with depression, aggression, delinquency, social withdrawal, hyperactivity, aixiety, and obsessive behaviors. These deficits were not exhibited across V1eboard but rather were demonstrated in symptom-specific ways and included both internalizing and externalizing disorders. Of interest was the finding that of the 23 COAs in this study, three emerged as problem-free on the CBCL and high in self-esteem on the PHSCS. While their TAT stories did contain the presence of unconscious conflicts and anxieties, they also contained elements of hopefulness and problem-solving abilities that were absent from the other COA stories. Might these children represent an “invulnerable” child who doesn’t develop the maladaptive traits
PERCEPTIONS OF SELF IN CHILDREN OF ALCOHOLICS
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seen in adult children of alcoholics? These might be the “resilient” (Garmezy and Masten, 1985) children who are able to avoid the pathological consequences of being reared in alcohol-related problem homes. Future research is needed to determine if high self-esteem scores, absence of behavioral problems, and positive TAT stories may serve as a “psychological marker” for such “invulnerability. There are several limitations of this study. First, the sample size was relatively small ( N = 65). Second, the absence of random selection makes the presence of other contributing variables (e.g., severity of parental drinking, child’s age at onset of parental alcoholism, degree of family dysfunction, etc.) more likely to affect the results. Third, ideally, all three groups should have been compared on the CBCL. The omission of the disturbed control group on this measure obviously resulted in a loss of possibly important information. Fourth, the quantitative scoring system used to assess unconscious self-concept was not sensitive enough to reveal the many negative images there were seen upon clinical analysis. However, despite these limitations, the basic finding remains: COAs represent an “at risk” group whose positive conscious selfperception belies the many behavioral problems reported by their parents and the many negative aspects of their inner mental life revealed in qualitative analysis of their TAT stories.
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”
ACHENBACH, T. M., and MCCONAUGHY, S. H. (1987). Empirically Bused Assessment of Child and Adolescent Psychopathology: Pructical Applications. Newbury Park, California: Sage Publishers. BARAGA, D. J. (1978). Self-concept of alcoholics. Diss. Abstr. In!. 39: 368. BLACK, C. (1979). Children of alcoholics. Alcohol Health Res. World 4: 23-27. COSDEN, M. (1984). Piers-Harris Children’s Self-concept Scale. In D. Keyser and R. Sweetland (eds.), Test Critiques, Vol. 1. New York: Test Corporation of America, pp. 51 1-521. EDWARDS, D. M., and ZANDER, T. A . (1985). Children of alcoholics: Background and strategies for the counselor. Elem. Sch. Guid. Couns. pp. 122-127, December. FINE, R. (1951). Techniques of thematic test analysis. In E. S. Schneidman (ed.), Thematic Test Analysis. New York: Grune and Stratton. GARMEZY, N., and MASTEN, A. S. (1985). Risk, vulnerability and protective factors in developmental psychopathology. In B. B. Lahey and A. E. Kazdin (eds.), Advances in Clinical Child Psychology, Vol. 8 . New York: Plenum Press, pp. 1-53. HERJANIC, B., HERJANIC, M., WETZEL, R., and TOMERELLI, C. (1978). Substance abuse: Its effects on offspring. Res. Commun. Psychol. Psychiatry Behav. 3: 65-75. HUGHES, H. M. (1984). Measures of self-concept and self-esteem for children ages 3-12: A review and recommendations. Clin. Psychol. Rev. 4:657-692. HUGHES, J. M. (1977). Adolescent children of alcoholic parents and the relationship of Alateen to these children. J. Consult. Clin. Psychol. 45: 946-947. KLEBENOFF, S . (1951). Techniques of thematic test analysis. In E. S. Schneidman (ed.), Thematic Test Analysis. New York: Grune and Stratton.
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MACHOVER, K. (1949). Personality Projection in the Drawing of the Human Figure. Springfield, Illinois: Thomas. MAGRAB, P. R. (ed.) (1984). Psychological and Behavioral Assessment in Pediatric Care. New York: Plenum Press. MURRAY, H. A. (1943). Thematic Apperception Test Manual. Cambridge, Massachusetts: Harvard University Press. OGDON, D. P. (1967). Psychodiagnostics and Personality Assessment: A Handbook, 2nd ed. Los Angeles: Western Psychology Services. O'GORMAN, P. (1975). Self-concept, Locus of Control and Perceptions of Father on Adolescents from Homes with and without Severe Drinking Problems. Unpublished Doctoral Dissertation. Fordham University, New York. PIERS, E. V., and HARRIS, D. B. (1969). The Piers-Harris Children's Self-concept Scales. Los Angeles: Western Psychology Services. ROOSA, M. W., SANDLER, 1. N., GEHRING, M., BEALS, J., and CAPPO, L. (1988). The children of alcoholics life-event schedule: A stress scale for children of alcohol-abusing parents. J. Stud. Alcohol 49: 422-429. STOVALL, G . , and CRAIG, R. J. (1990). Mental representations of physically and sexually abused latency-aged females. Child Abuse Negl. 14: 233-242. WEGSCHEDIER-CRUISE, S. (1976). The Family Trap: Noone Escapes from a Chemically Dependent Family. Minneapolis: The Johnson Institute. WOODSIDE, M. (1988). Research on children of alcoholics: Past and future. Br. J . Addict. 83: 785-792.
THE AUTHORS Paula Markowitz, Psy .D., recently completed her doctoral studies in clinical psychology and is in private practice. Robert J. Craig, Ph.D., is on the Core Faculty of the Illinois School of Professional Psychology, the Director of the Drug Dependence Treatment Program at West Side VA Medical Center, Chicago, and a Consulting Editor to the Journal of Personality Assessment. He has been a frequent contributor to the International Journal of the Addictions.
The International Journal of the Addictions, 27(10), 1187-1 196, 1992
Conscious and Unconscious Perceptions of Self in Children of Alcoholics* Paula Markowitz, Psy.D., and Robert J. Craig, Ph.D.+ Illinois School of Professional Psychology, Chicago, Illinois 60604
ABSTRACT The conscious and unconscious self-concept was examined in three groups of children: 23 children of alcoholics (COA), 19 children from nonalcoholic but dysfunctional families, and 23 children from normal families without alcoholism or family dysfunction. Self-concept was assessed both objectively, using the Piers-Harris Children's Self Concept Scale, and subjectively, using the Draw-A-Person Test and the Thematic Apperception Test from rating systems designed to tap unconscious dimensions of self. The COAs and normal controls were also compared for behavioral problems with the Achenbach Child Behavior Checklist. We found that COAs made more positive selfstatements on objective measures of self-concept than children from families without alcoholism, whether or not the families were dysfunctional. Subjective analyses of projective test responses revealed unconscious differences in self-concept among the COAs, though this was not corroborated with objective scores, probably due to the crudeness of the rating instrument in failing to tap these dimensions. Also
*This study was based, in part, on a dissertation completed at the Illinois School of Professional Psychology by P.M. under the supervision of R.J.C. 'Address reprint requests to Robert J . Craig, Ph.D., Illinois School of Professional Psychology, 220 S.State St., 5th Floor, Chicago, Illinois 60604. I187 Copyright 01992 by Marcel Dekker, Inc
I I88
MARKOWITZ A N D CRAIG
COAs had significantly more behavior problems, based on parental reports, which contrasts with their objective reports of self. Implications of these findings were discussed.
Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
INTRODUCTION There are an estimated 28 to 34 million children of alcoholics (COAs), including 12 to 15 million under the age of 18 who are currently living with at least one alcoholic parent (Edwards and Zander, 1985; Woodside, 1988). The literature documents a myriad of psychological and emotional problems extant in this “at risk” population (Black, 1979; Wegschedier-Cruise, 1976). Noted also is that the majority of these children are doing well, despite the “appearance of survival.” The literature suggests that when they reach adulthood, the apparent adaptive, successful, and positive response patterns that were functional in childhood become dysfunctional in adult roles. The central organizing concept that has guided much of this clinical theorizing has been the “self-concept,” “self-esteem,” or “self-perception.” Most clinical explanations of these adult troubles in COAs focus on the belief that the core sense of self is profoundly influenced by the character and degree of early parental relationships. In an alcoholic family, the abusive, nonemphathic, and exploitative aspects of family functioning become introjected into pathological patterns. What emerges are “roles,” variously reported as “hero,” “scapegoat,” “lost child,” “mascot,” “adjuster,” and “placator,” which seem functional and adaptive in childhood but which become maladaptive in adult roles. The original function of these roles, according to theorists, is to help the children cope successfully with the family’s problems and to reduce the emotional pain of growing up in an alcoholic home. Studies are only beginning to appear that assess the self-concept of COAs as compared to other groups. The majority of these studies found that the selfesteem scores of COAs are lower than those other groups (Baraga, 1978; Hughes, 1977; O’Gorman, 1975; Roosa et al., 1988) although Herjanic et al. (1978) found that inner city COAs had average to above average self-esteem scores on the Piers-Harris Self-concept Scale (PHSCS). The unusual aspect of such research is that it has focused entirely on conscious self-reports, whereas the clinical theory driving this research has placed major emphasis on the unconscious determinations affecting subsequent adult behaviors in this population. The purpose of this present study was to examine the self-esteem in children who have been raised in alcoholic homes compared to children who have grown up in distressed families with no alcohol problems and children from stable homes with no alcoholism. We use both objective and projective methods to compare the conscious and unconscious aspects of the self-concept in a COA group.
PERCEPTIONS OF SELF IN CHILDREN OF ALCOHOLICS
I189
SUBJECTS
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A total of 65 subjects was obtained for this study. Each subject volunteered for the study, and an informed consent was obtained from the parent or legal guardian.
Group 1. This group consisted of 23 children of alcoholics who had at least one alcoholic parent. These children were attending a COA suport group at a local alcohol treatment facility. The group consisted of 12 females and 11 males with a mean age of 10.7. Ten had alcoholic fathers, three had alcoholic mothers, and the remainder lived in homes where both parents were alcoholics. Seventeen were White, four Black, and two Hispanic. Group 2. Subjects in Group 2 consisted of 19 children who lived in a distressed home environment where families were dysfunctional in a variety of ways but did not have parental alcoholism. There were 13 females and 6 males with a mean age of 10.9. Ten were White, seven Black and two Hispanic. They were obtained through a major university’s department of child and adolescent psychiatry where they were receiving mental health services for problems related to school or behavior. No alcoholism was reported in these homes. Group 3. This group consisted of 23 children without evidence of academic or behavioral problems and who lived in homes without current or histories of parental alcoholism. There were 16 females and 7 males with a mean age of 10.5. Ten were White, seven Black, and six Hispanic. They were recruited through a local public elementary school. There were no significant differences in age between the three groups of children ( F = .39, P > . 0 5 ) .
INSTRUMENTS The Draw-A-Person (DAP) Test (Machover, 1949; Ogdon, 1967) and the Thematic Apperception Test (TAT) were used as measures of unconscious self-concept (Magrab, 1984; Murray, 1943). The Piers-Harris Children’s Self-concept Scale (Cosden, 1984; Hughes, 1984; Piers and Harris, 1969) was used to measure conscious self-concept. The Achenbach Child Behavior Checklist (CBCL) was used to measure behavior problems (Achenbach and McConaughy, 1987). On the DAP, self-esteem was assessed by the height of a human figure drawing in centimeters (Machover, 1949). On the TAT, we developed a scoring system to measure self-esteem, based on the empirical work of Fine (1951) and Klebenoff (1951), which required two trained raters to blindly assess each TAT story along the dimensions of feelings, outcomes, conjiict resolutions, and qualify of object relations. A qualitative analysis of the TAT stories was also performed to add richness and comprehensiveness to the results. This consisted
i I90
MARKOWITZ AND CRAIG
Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
of a detailed subjective analysis of each card with a focus on unconscious communications. The Piers-Harris test is objectively scored and provides a total score and six subscale scores dealing with various aspects of self. The CBCL is also objectively scored and provides quantitative data in nine behavior problem areas.
PROCEDURE Although identical procedures for participation would have been desirable, practical difficulties in obtaining these types of subjects made this impossible. Thus, it was necessary to sacrifice some methodological rigor in lieu of practicality. Children from alcoholic and normal populations were tested in small groups. Each subject was given a packet which included a blank piece of 8 % ' ' ~ll"paper, with the heading "Draw A Person," the PHSCS, and six TAT pictures with accompanying instructions as suggested by Murray (1943). Children were allowed to work through the packet at their own pace, and the senior author was available to help with individual questions. Subjects from distressed families were tested individually as part of a more comprehensive evaluation. Parents from the alcoholic and normal groups completed the CBCL either at the time of initial testing or at home. Although it would have been desirable to have parents of the disturbed controls complete this test as well, this instrument only became available to us later and after this group had already been tested. Table 1 presents an overview of the groups and tests administered.
RESULTS Quantitative
DAP. The dependent variable was the length of the human figure drawing in centimeters. An analysis of variance performed across all three groups found no significant differences in the length of drawings ( F = 2.10, P > .05). PHCSCS. First, a multivariate analysis of variance was performed across the seven scales (total score and six subscales) and was significant (Wilks' lambda p < .01). Next, an analysis of variance was conducted followed by planned comparison tests using Fisher's Least Significant Different Test (LSD). These results are presented in Table 2. Statistically significant differences occurred between groups on all scales except Intellectual and Social Status. Fisher's LSD test revealed that the COAs were significantly different
I191
PERCEPTIONS OF SELF IN CHILDREN OF ALCOHOLICS
Table 1. Group Demographics
Groups I
Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
Variables
I1
111
TY Pe
23 Children of Alcoholics
19 Children in nonalcoholic dysfunctional families
23 Normal children in nonalcoholic, nondysfunctional families
Mean age (years)
10.7
10.9
10.5
Males
11
6
7
Females
12
13
16
White
17
10
10
Black
4
I
I
2
2
6
Yes
Yes
Yes
Piers-Harris Children’s SelfConcept Scale
Yes
Yes
Yes
Thematic Apperception Test
Yes
Yes
Yes
Achenbach Child Behavior Checklist
Yes
No
Yes
N
Hispanic Instruments: Draw-A-Person Test
from the normal group in the areas of physical appearance and popularity and from the disturbed controls in behavior, anxiety, popularity, happiness and in overall self-concept scores. These results show that COAs made more positive self-statements than children from families without alcoholism, whether or not those families were dysfunctional. On a conscious level, the COAs demonstrated the highest self-esteem of all three groups.
TAT. Interrater reliability between the two raters averaged .85 across all scales for all 65 subjects. A multivariate ANOVA was then executed and was not significant (Wilks’ lambda p > .05). A subsequent univariate ANOVA was also performed, and only one of 16 possible variables reached significance-a result that was attributed to chance.
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Table 2.
Piers-Harris Children's Self-Concept Scale Scares between Groups
Groups Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
~
~~
I KOA) Scales Total score Behavior Intellectual and Social Status Physical Appearance Anxiety Popularity Happiness and Satisfaction
M
SD
11
111
(BC)
(NORM)
M
SD
M
SD
F
P
58.8 52.3 55.6
8.33 8.88 7.76
51.9 46.1 50.7
10.21 8.15 10.33
54.6 53.9 52.9
7.06 7.74 8.74
3.31" 4.60a 1.55
.04
59.3 58.0 55.2 58.6
10.30 8.10 9.96 7.05
53.1 49.0 47.1 48.1
11.36 13.40
50.7 54.0 48.80 54.5
8.30 8.88 7.27 7.63
4.51" 3.85" 4.35" 7.19
.01
11.11
11.10
.01
.22
.02 .02 ,001
Statistically significant.
CBCL. A MANOVA was significant (Wilks' lambda p < .01) for the 15 scales of the CBCL. Each scale was then analzyed individually by using a univariate ANOVA. The results are presented in Table 3. Except for four subscales, the COAs exhibited significantly more behavioral problems than normal controls on all other subscales. Although the sample was small, we performed separate analysis by gender and race and found significant differences. Therefore, an analysis of covariance (ANCOVA) was performed controlling for the effects of gender and race, and the results remained essentially unchanged. After adjustment, the COAs differed from the disturbed control group on the additional variable of physical appearance (P< -03).Again, the COAs scored higher on this measure. To summarize, the COAs had the highest conscious self-esteem of all three groups on the PHSCS, but they also demonstrated significantly more behavior problems than children from normal families. Objective scoring systems applied to the TAT and DAP found no significant differences in unconscious self-esteem. Because of the difficulty in quantifying these unconscious processes, a clinical qualitative analysis was then conducted to tap this rich material. Qualitative Analysis
Although our rating system did not find any differences in unconscious self-perceptions between groups, we did notice some common themes in the
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PERCEPTIONS OF SELF IN CHILDREN OF ALCOHOLICS
Table 3. Behavior Checklist Scores
Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
Groups
I (CON Scales Total score Externalizing Internalizing Depression Social Withdrawal Somatic Complaints Hyperactive Delinquent Aggressive Schizoid Anxious Obsessive Compulsive Uncommunicative Schizoid Obsessive Sex Problems Cruelty
I1
(NORM)
M
SD
M
SD
F
P
66.4 65.0 65.3 67.6 65.7 61.1 64.7 68.9 66.0 63.5 63.3 71.2 63.4 61.5 64.3
10.29 10.38 10.13 9.57 7.80 6.10 10.40 8.11 11.39 7.63 10.72 12.90 6.99 8.73 9.33
49.7 50.5 49.6 56.0 57.3 58.2 55.9 59.9 56.6 55 .O 55.8 59.8 56.8 58.6 58.9
8.49 7.23 9.03 2.32 4.17 5.89 I .82 4.40 3.24 0 1.10 8.67 3.40 5.48 5.48
36.45a 29.67a 29.74a 30.85" 19.92" 2.52 15 .0ga 2 I .38' 13.91" 5.90" 2.33 3.17 1 I .44" 1.17 3.93
.OoO1 .OoO1
.OoOI .oO01
.OoOI .I2
.o004 .OoOI
.o006 .03
.I5 .I0
,002 .29 .06
Statistically significant
TAT stories of the COA group. We found that the COA stories contained themes and imagery where parental concern and attention were frequently absent. Rather than seeing parental figures as nurturing, parents were seen as hostile, destructive, and abandoning. The children often exhibited excessive self-reliance and feelings of responsibility to care for their distressed parents. At the same time they felt helpless, frightened, and confused. The most frequent image that occurred across all cards in the COA group was the devastating effects of drugs and alcohol on the family. The resulting feelings of anger, grief, and frustration invariably surfaced with characters using questionable ways to manage them. Substance abuse was described as leading to marital discord, leaving children abandoned, and disrupting childhood dreams. Violins, dolls, and other possessions were broken, children were portrayed as hungry orphans desperate to be fed and clothed, and young children were beaten, slapped, chased, and neglected. Likewise, there were descriptions of horrific car accidents, birds falling from trees, bears ripping little children apart, overworked slaves enduring a life of hard labor, and bursts
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of uncontrolled violence such as burning, smashing, stabbing, choking, ripping, slicing, and murdering. The basic feeling permeating the stories of the COAs was one of being neglected or forgotten by the parent.
Subst Use Misuse Downloaded from informahealthcare.com by University of British Columbia on 12/10/14 For personal use only.
DISCUSSION Children of alcoholics (COAs) have been described as outwardly appearing happy, competent, and well-adjusted, but beneath this veneer they harbor unconscious negative self-perceptions and low self-esteem. We found that the conscious self-concepts of COAs actually were higher than those of the other two groups, and this finding appeared across almost all scales of the PiersHarris Children’s Self Concept Scale, while children from dysfunctional families without alcoholism scored lowest on self-esteem in all three groups. In contrast, we found no differences in self-concept between groups in their unconscious self-perceptions upon quantitative analysis. These findings appear surprising, perplexing, and somewhat contradictory. Particularly troublesome was the finding that COAs had the highest amount of self-esteem by self-report, especially when they came from families that the literature describes as characterized by parental instability, neglect, and emotional malnourishment. However, prior research with the PHSCS has also found contradictions concerning whether or not COAs have high or low selfesteem (Baraga, 1978; Herjanic et al., 1978; and O’Gorman, 1975). We believe that there is not one universal finding for COAs regarding high or low self-esteem. If one parent is able to provide a stable and nurturing relationship with the child, despite the presence of familial alcoholism in their spouse, then a positive self-concept is possible. Another explanation is that their high scores may reflect overcompensation as an adaptive behavior. This externally positive self-image may be a protective shield to defend against intense stress and intolerable feelings. Consider the additional finding that, despite their report of high selfesteem, the COAs had a high degree of behavioral difficulties on the CBCL. These included more problems with depression, aggression, delinquency, social withdrawal, hyperactivity, aixiety, and obsessive behaviors. These deficits were not exhibited across V1eboard but rather were demonstrated in symptom-specific ways and included both internalizing and externalizing disorders. Of interest was the finding that of the 23 COAs in this study, three emerged as problem-free on the CBCL and high in self-esteem on the PHSCS. While their TAT stories did contain the presence of unconscious conflicts and anxieties, they also contained elements of hopefulness and problem-solving abilities that were absent from the other COA stories. Might these children represent an “invulnerable” child who doesn’t develop the maladaptive traits
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seen in adult children of alcoholics? These might be the “resilient” (Garmezy and Masten, 1985) children who are able to avoid the pathological consequences of being reared in alcohol-related problem homes. Future research is needed to determine if high self-esteem scores, absence of behavioral problems, and positive TAT stories may serve as a “psychological marker” for such “invulnerability. There are several limitations of this study. First, the sample size was relatively small ( N = 65). Second, the absence of random selection makes the presence of other contributing variables (e.g., severity of parental drinking, child’s age at onset of parental alcoholism, degree of family dysfunction, etc.) more likely to affect the results. Third, ideally, all three groups should have been compared on the CBCL. The omission of the disturbed control group on this measure obviously resulted in a loss of possibly important information. Fourth, the quantitative scoring system used to assess unconscious self-concept was not sensitive enough to reveal the many negative images there were seen upon clinical analysis. However, despite these limitations, the basic finding remains: COAs represent an “at risk” group whose positive conscious selfperception belies the many behavioral problems reported by their parents and the many negative aspects of their inner mental life revealed in qualitative analysis of their TAT stories.
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”
ACHENBACH, T. M., and MCCONAUGHY, S. H. (1987). Empirically Bused Assessment of Child and Adolescent Psychopathology: Pructical Applications. Newbury Park, California: Sage Publishers. BARAGA, D. J. (1978). Self-concept of alcoholics. Diss. Abstr. In!. 39: 368. BLACK, C. (1979). Children of alcoholics. Alcohol Health Res. World 4: 23-27. COSDEN, M. (1984). Piers-Harris Children’s Self-concept Scale. In D. Keyser and R. Sweetland (eds.), Test Critiques, Vol. 1. New York: Test Corporation of America, pp. 51 1-521. EDWARDS, D. M., and ZANDER, T. A . (1985). Children of alcoholics: Background and strategies for the counselor. Elem. Sch. Guid. Couns. pp. 122-127, December. FINE, R. (1951). Techniques of thematic test analysis. In E. S. Schneidman (ed.), Thematic Test Analysis. New York: Grune and Stratton. GARMEZY, N., and MASTEN, A. S. (1985). Risk, vulnerability and protective factors in developmental psychopathology. In B. B. Lahey and A. E. Kazdin (eds.), Advances in Clinical Child Psychology, Vol. 8 . New York: Plenum Press, pp. 1-53. HERJANIC, B., HERJANIC, M., WETZEL, R., and TOMERELLI, C. (1978). Substance abuse: Its effects on offspring. Res. Commun. Psychol. Psychiatry Behav. 3: 65-75. HUGHES, H. M. (1984). Measures of self-concept and self-esteem for children ages 3-12: A review and recommendations. Clin. Psychol. Rev. 4:657-692. HUGHES, J. M. (1977). Adolescent children of alcoholic parents and the relationship of Alateen to these children. J. Consult. Clin. Psychol. 45: 946-947. KLEBENOFF, S . (1951). Techniques of thematic test analysis. In E. S. Schneidman (ed.), Thematic Test Analysis. New York: Grune and Stratton.
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THE AUTHORS Paula Markowitz, Psy .D., recently completed her doctoral studies in clinical psychology and is in private practice. Robert J. Craig, Ph.D., is on the Core Faculty of the Illinois School of Professional Psychology, the Director of the Drug Dependence Treatment Program at West Side VA Medical Center, Chicago, and a Consulting Editor to the Journal of Personality Assessment. He has been a frequent contributor to the International Journal of the Addictions.
