Family interaction in disturbed and normal families: a methadological and substantive review.

Psychological Bulletin 1975, Vol. 82, No. 1, 33-65

Family Interaction in Disturbed and Normal Families: A Methodological and Substantive Review Theodore Jacob University of Pittsburgh Fifty-seven direct observation studies comparing family interaction in disturbed (schizophrenic and nonschizophrenic) and normal families were systematically evaluated. Major sections of the review include (a) a critical evaluation of the methodological adequacy of reviewed studies in terms of various design standards and controls; (b) an extensive review of substantive findings relevant to the content domains of dominance, conflict, affect, and communication clarity; and (c) a discussion of difficulties involved in comparison of results because of cross-study differences in diagnostic status of experimental groups, measurement techniques, type of analyses, and demographic factors.

During the past several decades, many investigators interested in the domain of psychopathology have shifted their attention from the individual to the larger interpersonal context in which the individual functions. By far, the most influential variant of this approach is reflected in the current focus on the nuclear family as the interpersonal context of primary importance and as the functional unit of study. In particular, most family investigators would suggest that there are definable family patterns and processes which are crucial to understanding the etiology, development, and maintenance of abnormal behavior and that identification of such family patterns might eventually lead to more effective methods of treatment and prevention. Several reviews of relevant empirical studies, however, provide little evidence for the contention of consistent, definable relationships between disturbance and family processes. Frank (1965), for example, stated categorically that no factors were found in the parent-child interaction of schizophrenics, neurotics, or those with behavior disorders which could be identified as unique to them or which could distinguish one group from the other, or any of the groups from the families of controls, (p. 191)

Like others (Fontana, 1966; Haley, 1972; Rabkin, 1965; Riskin & Faunce, 1972), Frank noted that the methodological limitaRequests for reprints should be sent to Theodore Jacob, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania 1S260.

tions characterizing the field severely limit conclusions that can be made. In particular, survey of family studies prior to the late 1950s indicates that almost all of the relevant data were based on survey questionnaires, case history analyses, psychological testing, and individual psychiatric interviews—procedures that have been characterized as methodologically weak or inadequate and as vulnerable to major interpretive difficulties. Specifically, the validity of such indirect, self-report procedures assumes that people are able and/or willing to accurately report events and feelings of the past and present and that such reports are minimally affected by forgetting, defensive distortion, or inaccurate elaboration, as a justification of actions. Given our present knowledge regarding the lack of congruence between reported and actual behavior (as well as system theory's contention that,knowledge of an individual member may not accurately predict that member's behavior in interaction with other system members), it would appear that the assumptions underlying self-report methods are questionable at best and untenable at worst (see Hess, 1970; Von Bertalanffy, 1962, 1966, 1968). As a result of these and other considerations, the last 15 years have witnessed an increasing number of direct observation studies, in which current patterns of interaction among both parents and one or more children are directly assessed and systematically coded. Although direct observation procedures are not without methodological weaknesses (as can be 33 .

34

THEODORE JACOB

seen in the following section), it can be argued that this strategy requires fewer assumptions and/or inferences than self-report procedures and, at least potentially, represents a scientifically sound methodology. As noted by Fontana (1966), If the inconclusiveness of the etiological assumption is granted and accepted, then there is no apparent, intrinsic methodological inadequacies to the study of family interaction which would disqualify it [the direct observation method] as a scientific endeavor, (p. 218)

Although several previous reviews of direct observation studies are available, these reports have usually been limited to studies including a schizophrenic sample or limited to methodological considerations. More important, however, is the fact that almost all direct observation studies have appeared since 1960, and nearly 50% of these have appeared since 1968; as such, previous reviews have evaluated only a small proportion of the total number of relevant investigations.1 The purpose of the present review is to critically evaluate family interaction studies2 which have compared disturbed (schizophrenic and nonschizophrenic) and control families and which have included both parents and at least one child as participants in the assessed interactions. Specifically, the review is organized in terms of the following format: 1. An overview of the relevant studies is presented and includes a description of their major identifying characteristics as well as a critical evaluation of their methodological adequacy. 2. With the aforementioned considerations (and resultant limitations) acknowledged, 1

Fontana (1966) and Sanua (1961) reviewed studies which included schizophrenic samples, Frank (1965) and Haley (1972) reviewed studies which included both schizophrenic and nonschizophrenic disturbed samples, and Rabkin (1965) reviewed methodological issues involved in family studies. The most recent review (Riskin & Faunce, 1972) discussed a number of issues related to family interaction research but differs greatly from the present article in terms of the critical and systematic evaluation of methodological and substantive issues reflected in the present article. 2 In the present review, family interaction, family interaction studies, and family interaction research refer to investigations and findings based on direct observation procedures.

substantive findings relevant to four major interactional domains (i.e., family patterns of conflict, dominance, affect, and communication clarity) are reviewed. 3. Difficulties in the evaluation and comparison of results from different studies are discussed. Specifically, a number of demographic and methodological variables, which have varied greatly across studies and which recent evidence suggests to be importantly related to differing patterns of family interaction, are identified and discussed. DESCRIPTIVE AND METHODOLOGICAL CHARACTERISTICS OF DIRECT OBSERVATION STUDIES The general paradigm of family interaction research has been characterized by the systematic observation, recording, and coding of the interactions of experimental and control families as the members are engaged in "free" interaction or in the performance of an experimental task. Notwithstanding differences among studies as to the nature of the disturbed and control groups, the setting in which observations were made, and the type of experimental task presented to the family, the defining characteristic of all studies reviewed is that members' interactions vis-a-vis other members have been assessed in a direct, systematic, and controlled manner. Although families were assessed by direct observation procedures during the early 1950s, interest was limited either to normal family groups (Strodtbeck, 1954) or to the development and refinement of techniques in the context of pilot studies (see Haley, 1972, p. 20). In contrast with these early reports, it was not until the late 1950s that a reasonably wellcontrolled study of disturbed and normal family interaction appeared (Behrens & Goldfarb, 1958), and since that time 57 articles have assessed disturbed and normal family groups by means of direct observation methodologies.3 As seen in Table 1, 13 studies have assessed the interactions of schizophrenic, disturbed nonschizophrenic, and normal families; 14 3 The literature search ended in June 1973, and with the exception of two studies (Bodin, 1966; Hutchinson, 1967), I did not attempt to locate unpublished theses and dissertations.

INTERACTION

IN DISTURBED AND NORMAL

studies have assessed schizophrenic and normal families; and 25 studies have assessed disturbed nonschizophrenic and normal families.4 Table 1 also indicates that whereas 66% of the studies comparing schizophrenic and normal controls (with or without a disturbed group) appeared prior to 1968, nearly 60% of the studies comparing disturbed and normal controls have appeared since 1968. Also it should be noted that there have been 5 studies which included only schizophrenic subgroups (Baxter, Arthur, Flood, & Hedgepeth, 1962; Farina & Dunham, 1963; Sharan, 1966) or disturbed subgroups (Goldstein, Rodnick, Judd, & Gould, 1970; McPherson, 1970), and although significant subgroup differences were often obtained, comparison of these studies with investigations including normal controls is often difficult, if not impossible. Finally, it should be noted that the 57 cited articles are associated with a substantially smaller number of actual samples on which reports have been based; for example, one sample generated 7 of the 57 cited articles (Ferreira & Winter, 1965, 1968b; Ferreira, Winter, & Poindexter, 1966; Winter & Ferreira, 1967, 1969; Winter, Ferreira, & Olson, 1965, 1966). To anyone familiar with the tremendous time commitment required to implement a direct observation study of family interaction, the desirability (and oftentimes the necessity) of using common samples is readily understandable. The potential danger resulting from such collaborative strategies is, of course, that of "probability pyramiding," by which one fails to adjust probability estimates when a multitude of significance tests are performed on the same set of data. In overview, then, the study of disturbed and normal family interaction by means of direct observation procedures is of recent origin, the first controlled study reported less than 16 years ago. In survey of the 57 relevant articles which have appeared since that time, it is clear that (a) family interaction 4 Schizophrenic and nonschizophrenic disturbed families (fathers, mothers, or children) refer to families containing one individual who has been so labeled or diagnosed. Similarly, the term good (or poor) premorbid family (father, mother, or child) refers to a family containing a schizophrenic member who has been described as reflecting a good (or poor) premorbid social history.

FAMILIES

35

research was initially associated with and focused on families containing a schizophrenic member; (b) the more recent direct observation studies have focused on nonschizophrenic disturbance with special interest in families containing a delinquent child (e.g., Alexander, 1973a, 1973b, Note 1; Bodin, 1966; Hetherington, Stouwie, & Ridberg, 1971; Mead & Campbell, 1972); and (c) a relatively small proportion of reported studies (13 of 57) included schizophrenic, nonschizophrenic disturbed, and normal family groups. As previously noted, interpretation of data obtained from direct observation procedures rests on fewer assumptions and inferences than does evaluation of self-report data and as such represents a potentially sound and scientific methodology. Notwithstanding such differences in underlying assumptions, however, there are certain methodological standards and controls that should be attained by any data collection procedure so that a particular study's findings can be interpreted with minimum ambiguity and uncertainty. For example, one should be reasonably confident that reported group differences were based on "blind" coding procedures characterized by adequate interjudge agreement and that experimental and control groups were comparable in terms of potentially influential demographic variables. In addition to such common standards, however, there are several concerns unique to direct observation procedures which should be considered in evaluating a study's methodological adequacy. Before proceeding to a review of substantive findings, then, it is important to evaluate the methodological adequacy of direct observation studies because identified shortcomings will necessarily affect and limit the substantive conclusions that can be drawn. Specifically, six standards and controls provide the basis on which the methodological adequacy of direct observation studies can be evaluated. 1. Experimental and control families should be comparable on demographic variables found to be (or strongly suggested to be) related to different patterns of family interaction. In particular, age of child (Ferreira, 1963a, 1963b; Ferreira & Winter, 1968a; Jacob, 1974,-^ Murrell & Stachowiak, 1967), sex of child (Baxter et al., 1962; Ferreira, 1963a,

36

THEODORE

JACOB

TABLE 1 CHRONOLOGICAL SUMMARY OE BISECT OBSERVATION STUDIES A. Studies including schizophrenic families Year of publication S subgroups*

Before 1961 1961 1962 1963 1964 196S 1966 1967 1968 1969 1970 1971 1972 1973 Total

S N '

S, D, N 1

1

1

2

1 2 4 1 3

3

2 2 3 2

2

Total

B. Studies including nonschizophrenic disturbed families D subgroupsb

Total (A + B) n K

'

1 1

1 1

3 1 2 7

1 1 1

1 1 1

3

2 4 1 2

2 4 1 2 S 5 3 2 27

2 6 2 2

2

.3

5 3 2 3

14

13

Total

30

2

25

4 2 3

7 S 6 7 4 7 5

•

3 2 57

JVote. S = schizophrenic, D = disturbed (nonschizophrenic), N = normal. Technically, the McCord et al. (1962) sample included schizophrenic as well as other psychotic disturbances, and the comparison group in the Farina and Holzberg (1968) study was a disturbed rather than normal control group. » See Baxter, Arthur, Flood, & Hedgepeth (1962), Farina & Dunham, 1963, and Sharan, 1966. b See Goldstein, Rodnick, Judd, & Gould (1970) and McPherson, 1970.

1963b; Ferreira & Winter, 1965; Hetherington et al., 1971; Hutchinson, 1967; Mishler & Waxier, 1968), birth order of child (Schooler, 1961, 1964; Schooler & Scarr, 1962), family social class (Alkire, 1969; Baxter & Arthur, 1964; Becker & Iwakami, 1969; Jacob, 1974), religion and ethnicity (Sanua, 1961, 1963), and family size and parents' ages (see Fontana, 1966, p. 220) should be comparable between family groups. At best, failure to equate groups on such dimensions will greatly increase error variance (making significant group differences more difficult to identify); at worst, obtained group differences may be associated with differences in diagnostic status (the independent variable) or differences in demographic variables, or both. 2. Where data are to be judged and categorized, raters should be ignorant of the family's diagnostic status. That the potential for bias becomes paramount when judges are aware of differences between experimental and control groups (and implicitly or explicitly aware of the experimenter's expectations) has been discussed extensively under the rubric of "experimenter bias effects" (Rosenthal, 1966). Directly related to family interaction

research is a finding reported by Haley (1972, p. 27): Highly experienced family therapists were unable to blindly identify (beyond chance) families containing a schizophrenic versus disturbed versus normal child from tape-recorded family discussions. At a minimum, such findings suggest that interactional differences between disturbed and normal families are less than obvious and that the influence of one's expectations can be considerable when aware of the family's status. 3. Considerable agreement should exist among independent judges as to the presence and frequency of the behavior to be rated. In essence, if different observers cannot agree (or be trained to agree) on the presence and frequency of particular interactions, serious doubts can be raised as to the "definability" of the dimension in question and, as a result, the probability of replicating, results with a different set of judges. 4. Data including male and female children should be analyzed separately as a function of child's sex. As previously indicated, a number of studies suggest that child's sex is importantly associated with differing patterns of family interaction and that child's sex and

INTERACTION IN DISTURBED AND NORMAL FAMILIES

diagnostic status (disturbed versus normal) may generate complex interactions. As a consequence, failure to analyze data separately for male and female children can result in a confounding of diagnostic status and child's sex so that interpretation of obtained results (whether significant or nonsignificant) becomes extremely problematic. 5. Experimental and control families should be observed and assessed in the same experimental setting. That the context is importantly associated with emergent behavior has been discussed by personality psychologists (Mischel, 1968), small group researchers (McGrath & Altaian, 1966), and animal behaviorists (Altman, 1965; Carpenter, 1964; Devore, 1965). In addition, family interaction data have suggested important differences in emergent behavior when families are observed in the home versus the laboratory (O'Rourke, 1963). Aside from difficulties in comparing studies which have observed all families in different contexts, the more immediate concern relates to differences in setting (in which families are observed) within any particular study. Specifically, it can be argued that studies which have assessed experimental and control families in different settings have increased differences between groups in terms of expectation and set; as a result, observable differences between groups may be associated with differences in diagnostic status or expectation and set, or both.5 5

As long as disturbed and normal families are explicitly selected because of their diagnostic status, initial differences in expectation and set are unavoidable (see Mead & Campbell, 1972, as an exception). The point to be made, however, is that certain safeguards can be undertaken so that whatever differences existing as a result of the selection procedure are not increased or reinforced. As previously discussed, one such safeguard is that experimental and control families are seen in the same setting. It can also be argued that the expectations of experimental and control families become more dissimilar as a function of remunerating control, but not experimental, families for their participation in the research project. In reviewing studies, it was determined that seven investigations including a schizophrenic sample (Cheek, 1964a, 1964b, 196Sb; Cheek & Anthony, 1970; Friedman & Friedman, 1970; Lennard, Beaulieu, & Embry, 1965) and two investigations including a nonschizophrenic disturbed sample (Becker & Iwakami, 1969; Leighton, Stollak, & Fergusson, 1971) paid control, but not experimental, families.

37

6. A final issue concerns the comparability of experimental and control families in terms of hospital or treatment status. Similar to the rationale for observing all families in the same setting, it would be important to minimize the possibility that observed differences between experimental and control families are related to the effects of (a) institutionalization or (b) past or present treatment experiences. In all studies including schizophrenic families, identified patients had received or were receiving inpatient or outpatient treatment, and as such, it would be hoped that families in one comparison group had treatment histories comparable to those of the experimental group. For example, where identified patients in the experimental group were hospitalized at the time of the study, an appropriate comparison group might include families containing a hospitalized, disturbed nonschizophrenic member or a hospitalized, nonpsychiatric member. A less comparable control group would include disturbed families who had received or were receiving outpatient treatment. The least comparable control group would be normal families with no history of inpatient or outpatient contact. In studies including nonhospitalized, nonschizophrenic disturbed groups, it would be suggested that the experimental group be assessed prior to receiving psychiatric treatment as a partial control for the effects that treatment intervention might exert on family patterns of relating and interacting. The potentially confounding or biasing effects that can result from failure to implement these controls have been discussed at considerable length by others (Fontana, 1966; Haley, 1962, 1972; Rabkin, 1965; Riskin & Faunce, 1972). Although additional methodological considerations could be discussed, these six issues can serve as a general basis on which the methodological adequacy of the reviewed studies are evaluated. The reviewer's judgments of the methodological status of the 57 family interaction studies are summarized in Table 2. Table 3 summarizes the number of studies meeting each of the standards for the 57 total studies, for the 30 studies including a schizophrenic group (with or without a nonschizophrenic disturbed group), and for the 27 studies including a nonschizophrenic

TABLE 2 METHODOLOGICAL SUMMARY op DIRECT OBSERVATION STUDIES Identified patient Study

Family types"

Demographic comparability of groups

N

Treatment comparability of groupsb

Blind coding0

Coding reliability

Setting comparabilityd

Type of setting" Sex
n F, M, C Family discussion

I I

TABLE 2—(Continued) Identified patient Study

McCord, Porta, & McCord (1962)

family types" N

P Ni

12 12 129

N!

McPherson (1970)

Di

6 9

D2

7

Da D4

Mead & Campbell (1972) Meyers & Goldfarb (1961)

D N

Mishler & Waxier (1968)

Sg-pr Sp-pr

Morris & Wynne (1965) Murrell (1971)

Sorg Sn-org

N

N S D Ni

i

10 10 10

N2

Murrell & Stachowiak (1967)

Na

D MR N

Reiss (1967)

S D N S D N S D N Di D2 Da

Reiss (1968) Reiss (1969) Riskin & Faunce (1970) Schuham (1970)

N Dpp N

Schuham (1972)

Dpp N

Schulman, Shoemaker & Moelis (1962)

D

N

Setting comparabilityd .


Good

Yes

Yes

Good

Same

lome

?air to questionable

Disturbed subgroups only

Yes

Good

Same

Outpatient clinic (UA) m, f

Good

Yes

AT

?air to good

No

No

Good

No

Yes

Good

Questionable

Yes

Yes

Fair to questionable

Yes

Yes

ndeter- Same minate Good Same

Yes

Yes

Good Good

11 Good

D N

O'Connor & Stachowiak (1971)

6 20 20 15 8 23 12 18 16 4

Coding reliability


11

Blind coding0

Sex'

Good

Same

__

'' teens") 6

Members in1 interaction .


Fam (u)

iome interactions

F, M; C

Discussion of previously recorded interaction

F, M, C

14-17) 8.5 (6-12)

Outpatient clinic

m, f(s)

22

F, M, C,S

Outpatient clinic m, f (NIMH) Outpatient clinic (UA) m, f

Not

stated 11.5 (10-12)

F, M, C, S(u) Family therapy sessions F, M, C, S UDT, family discussion"

Same


9.3

F, M, C, S

Same

Outpatient clinic (UA) m

C 11.5 (10-12) S 8.5 (6-not

Same

Yes

«

Fair to questionable

Yes

indeter- Indeter- Same minate minate

Outpatient clinic

\ Fair to questionable I Fair to questionable

Yes

Indeter- Good minate

Same

Outpatient clinic

Good

Same

Outpatient clinic

m, f m, f m, f

16-not stated)

(6-12)

Fam (u)

family discussion, TAT story construction, plan 0 something task

— (15-not

F, M, C, S

Pattern recognition task

— (15-not

F, M, C, S

Categorization task

— (15-not

F, M, C, S

Communication task

stated)

stated) stated)

Yes

Good

Same

Private research institute

m, f

\i Good l l Good i

Yes

Yes

Fair

Same

Research unit of hospital

m

12

Yes

Yes

Good

Same

Research unit of hospital

m

12

Good

No

Yes

Good

Same

Outpatient clinic (UA) m

2 2

RDT

RDT

No

i:

iome interactions

F, M, C, S

stated) 17*1 F, M, Si, 82, (6-21) Sa, (S4)i

1'^ Good

UDT

m, f

Yes

AT

6

Task

Home

ndeter- Same minate

Good to fair

Yes

m

Mean age (range) «

13-19)

1 J !

; «

.

Type of settings

(not stated) (not stated) 10

(8-12)

F, M, C

F, M, C F, M, C

Plan something together RDT RDT

Story completion task in playroom setting

1 Is

o to

TABLE 2—(Continued) Identified patient Study

Sharan (1966) Stabenau, Turpiii, Werner, & Pollin (1965) Winter & Ferreira (1967) Winter & Ferreira (1969) Winter, Ferreira, & Olson (1965) Winter, Ferreira, & Olson (1966)

Family types"

Sm

Sf

s

2V


12 Fair to inde12 terminate

D N S Di

5 Good to fair 5 5 10 Fair to good 12

Ds

33

N S Di D2 N S

35 16

17

44 50

Good

N S Di

16 Good 16 44 50 16 Good 16

Dj

44

N

50

Di D2


Blind coding0

Coding reliability

Setting comparabilityd

Good Same Schizophrenic Yes subgroups only Yes Indeter- Indeter- Same minate minate

Type of settings

Sex' Inpatient unit

m, f (s)

Outpatient clinic (NIMH)

m, f

Mean age (range) a

Members in interaction*

F, M, C,S (not stated) 18.5 F, M, C,S (14-28)

20

Task

Discussion of WAIS subtest in RDT format RDT

Probable

Yes

Indeterminate Professional offices, private research institute

m, f (s)

16

F, M, C

TAT story construction

Probable

Indeter- Indeter- Indeterminate Professional offices, rivate research minate minate istitute

m, f (s)

16

F, M, C


Fair to poor

S

(9.5-not stated) (9.5-not stated)

Probable

Yes

Good

Indeterminate Professional offices, private research institute

m, f(s)

16

F, M, C


Probable

Yes

Indeter- Indeterminate Professional offices, private research minate institute

m, f(s)

16

F, M, C


(9.5-not stated) (9.5-not stated)

»'S = schizophrenic, D = disturbed (nonschizophrenic), Syn = synthetic, P = psychotic, MR = mentally retarded, N = normal (no psychiatric contact), org = organic, n-org = nonorganic, g-pr = good premorbid, p-pr = poor premorbid, bl = black, wt = white, m = male identified patient, f = female identified patient, pp = prepsychotic, D-N = correlational techniques applied to a psychometrically defined range of disturbance-normality. Although disturbed groups in several studies contained some schizophrenic families (e.g., Ferreira, 1963; Ferreira & bWinter, 1966, 1968a; Haley, 1964, 1967a, 1967b), in most cases the majority of families were nonschizophrenic disturbed. For studies containing schizophrenic families, yes indicates that control families had received or were receiving inpatient or outpatient treatment, whereas no indicates that control families had no psychiatric history (inpatient or outpatient). For studies containing nonschizophrenic disturbed families, yes indicates that disturbed families had not received or were not receiving treatment prior to or at the time of the study, whereas no indicates that disturbed families had received or were receiving treatment prior to or at the time of the study. 0 AT = Automatically or machine tabulated. d Same = experimental and control families assessed in the same experimental setting. »f UA = university affiliated, NIMH = National Institute of Mental Health. m = male, f = female, (s) = analyzed separately. Although several studies indicated attempts to assess interaction patterns as a function of child's sex (e.g., Alkire, 1969; Ferreira & Winter, 1965), such procedures were not systematically performed and/or reported. K Mean age and range are expressed in years. t Average age of all participating children in disturbed group (groups). >Fam = family, F = father, M = mother, C = child (identified patient), S = sibling, (u) = unspecified, (S) = only included in some families. jk Child not always identified patient. 1 Modification of the revealed difference technique (Strodtbeck, 1951). See Jackson (1956). ™ See Watzlawick (1966). ' n 0 The interactions generated by each experimental task were combined and analyzed as a total. Although the disturbed group was subdivided into more homogeneous subgroups, major findings were discussed in terms of differences between the 10 normal families and the 20 total disturbed families.

g

&>. ,o

i ^ to

I tu

§

o to

TABLE 3 NUMBER OF STUDIES HAVING SATISFIED OR ATTAINED Six METHODOLOGICAL STANDARDS Demographic comparability of groups Studies'

Total

S After 1966 Before 1966

D After 1970 Before 1970

Treatment comparability of experimental and control groupsb

Coding reliability

Blind coding

Separate analyses for male and female identified patients

Experimental setting

'i

Good

Other

Yes

Probable or partial

No

28 10

29 20 8 12 9 4 5

22 8 5 3 14 11 3

13 7 S 2 6 0 6

15 11 4 7 4 2 2

7 3 18 11 7

SubIndeterminate groups only 2 1 1 0 1 0 1

S

3 1 2 2 2 0

Yes

29 11 8 317 14 3

No or Indeterminate

15 15 5 10 1 0 1

AT«

Good

Otherd

Yes

No

Male only

Same

Different

Indeterminate

13 4 2 2 9 1 8

27 11

17 15

16.

6 9 2 1 1

10 4 1 3 8 4 4

39 17 10 7 21 14

7 5 1 4 3 1 2

11

7

31 14 8 6 15 8

4 16 13 3

12 6 6 4 2 2

.

7

7

8 5 3 3 0 3

a S = studies containing schizophrenic subgroups only, schizophrenic and control families, and schizophrenic, nonschizophrenic disturbed, and control families; D = studies containing disturbed subgroups only, and disturbed and control families. b For studies containing schizophrenic families, yes indicates that control families had received or were receiving inpatient or outpatient treatment, whereas no indicates that control families had no psychiatric history (inpatient or outpatient). For studies containing (nonschizophrenic) disturbed families, yes indicates that disturbed families had not received or were not receiving treatment prior to or at the time of the study, whereas no indicates that disturbed families had received or were receiving treatment prior to or at the time of the study. °d AT = machine or automatically tabulated. Studies in which scores were automatically or machine tabulated are not included.

1 o

INTERACTION


disturbed group. In addition, Table 3 indicates changes over time in meeting these standards for the 30 studies including a schizophrenic group and for the 27 studies including a disturbed nonschizophrenic group. Inspection of these tables indicates that methodological adequacy (as indexed by the six controls) differs markedly as a function of the diagnostic status of experimental families. In particular, the great majority of studies containing disturbed nonschizophrenic families satisfied five of the stated criteria. Specifically, 94% of these studies implemented blind rating procedures, 89% reported high interrater agreement figures,8 78% definitely observed experimental and control families in the same setting, 66% reported good demographic comparability between groups, and 56% contained disturbed families who clearly had not received treatment prior to or at the time the study was conducted.7 Furthermore, a higher percentage of recent than of earlier studies assessed only disturbed families with no previous treatment (85% versus 25%), a time change that was similarly observed in the number of studies attaining demographic comparability of groups (73% versus 58%). The only methodological standard that the majority of these studies failed to attain was separate analysis of data as a function of child's sex (21%). In striking contrast with studies containing nonschizophrenic disturbed families, the majority of studies containing schizophrenic families failed to satisfy five of the six stated criteria. Specifically, 34% of these studies reported good demographic comparability of groups, 46% analyzed data separately as a function of child's sex, 42% reported blind rating procedure, 42% reported high interrater agreement, and 30% clearly achieved 6 In calculating these two percentages, studies in which data were automatically or machine tabulated were not included. This qualification also applies to the percentage figure associated with schizophrenic samples. 7 Studies containing only disturbed subgroups were not included in calculating this percentage figure. Likewise, studies containing only schizophrenic subgroups were not included in calculating the "percentage of studies attaining treatment comparability of experimental and control families.

FAMILIES

43

treatment comparability between experimental and control groups. The only methodological standard that the majority of these studies attained was assessment of experimental and control families in the same setting (63%). Inspection of Table 3 does suggest, however, that demographic comparability of groups, blind coding procedures, high interrater agreement, and treatment comparability between experimental and control groups have been achieved in the majority of recent versus earlier studies including schizophrenic families —trends which hopefully reflect increasing concern for the methodological base from which substantive findings must ultimately be interpreted. In general, however, it must be stated that the majority of investigators comparing schizophrenic and control families have not paid sufficient attention to criteria and standards by which a study's methodological adequacy is evaluated. To what extent and in what manner such methodological weaknesses affect interpretation of substantive findings are largely unknown and conjectural at best. At a minimum, however, conclusions drawn from studies characterized by such methodological shortcomings should be evaluated with considerable caution and with the reader's full appreciation that reported findings may be explained in a variety of ways. SUBSTANTIVE FINDINGS Although family interaction studies reveal a number of dimensions along which experimental and control families have been described, four major content domains have been assessed most frequently within the 57 relevant articles under review—conflict, dominance, affect, and communication clarity. In general, the researcher's focus on these dimensions has been influenced most significantly by family theories of schizophrenia that emerged during the past two decades. In particular, concepts such as pseudomutual relationships, styles of relating, transactional thought disorder (Wynne, Ryckoff, Day, & Hirsch, 1958), marital schism and marital skew (Lidz, Cornelison, Fleck, & Terry, 1957a, 1957b, 1958), double bind communications (Bateson, Jackson, Haley, & Weakland, 1956), and emotional divorce (Bowen, 1960, 1969), not to mention Fromm-

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Reichmann's (1948) highly influential notion of the schizophrenogenic mother, have directed attention to and can be subsumed within the more general domains of dominance, conflict, affect, and communication clarity.8 In addition to the influence of these family theories of schizophrenia (and associated concepts), however, the family researcher's focus on these content areas has been influenced by several other theoretical and research perspectives. Developmental and personality theories, for example, have long contended that particular patterns of parental affect, conflict, and control are associated with such child behavior as dependency, assertiveness, and hostility—a contention that has produced a significant body of theoretical-empirical literature devoted to investigation of these relationships.9 Similarly, the considerable amount of sociological and social-psychological literature concerned with group structure and development has importantly influenced the family investigator's selection of content areas; for example, the concept of role differentiation has been closely related to the dimensions of dominance (instrumental functions) and affect (socioemotional functions) and to the development and functioning of family groups (Bales, 1970; Parsons & Bales, 19SS). In overview, then, several theoretical and research perspectives within psychology, sociology, and psychiatry have influenced the family researcher's focus on the dimensions of conflict, dominance, affect, and communication clarity and have suggested that variations along these dimensions may be importantly related to differentiating disturbed (schizophrenic and nonschizophrenic) from normal families. In the remainder of this section, family interaction literature relevant to these four content areas is reviewed.10 Within each 8 See Mishler and Waxler's (1965) excellent review and analysis of family theories of schizophrenia. 9 Several edited texts contain excellent chapters which summarize the theoretical and empirical literature related to such parent-child relationships (Goslin, 1969; Parke, 1969). 10 Although the great majority of dependent variables has assessed the dimensions of conflict, dominance, affect, and communication clarity, several additional groupings can be identified. For example,

of the four substantive domains, studies containing schizophrenic families are reviewed first, followed by a review of studies containing disturbed nonschizophrenic families.11 In addition, conflict and dominance data are further divided on the basis of measurement techniques—that is, quantitative process measures, qualitative process measures, and outcome measures. Although the first and second types of measures both necessitate the rating of family behavior by judges, quantitative process measures (alternately called verbal frequency measures) only require the judge to determine the presence or absence of a rather objective, specific, and noninferential event (e.g., "talking time"). In contrast, qualitative process measures not only require the judge to determine the occurrence of an event but to determine the quality or kind of event that has occurred—judgments that often involve multilevel criteria and some degree of inference (e.g., "parent takes over"). Measures in the third group (outcome measures) only require one to determine the final product or outcome of a family performance, which,is usually accomplished by a "scoring" there are procedures which have assessed family productiveness and/or efficiency, as indexed by such measures as family decision time (e.g., Ferreira & Winter, 1965), turns to completion of a laboratory game (e.g., Reiss, 1969), and number of descriptive phrases produced by family members in 10 minutes (e.g., Murrell, 1971). Another group of procedures assessed distribution and/or direction of family communications, as indexed by such measures as amount of talking or silence within a given time period (e.g., Ferreira & Winter, 1968b), who-speaks-after-whom sequences (e.g., Ferreira et al., 1966), and participation evenness (e.g., Haley, 1964; Murrell & Stachowiak, 1967). 11 It should be noted that investigations by Baxter et al. (1962), Farina and Dunham (1963), Goldstein et al. (1970), McPherson (1970), and Sharan (1966) included -only disturbed subgroups and are not discussed in the text of the present article. In addition, several studies containing schizophrenic or nonschizophrenic disturbed subgroups and a normal control group reported reliable subgroup differences but not reliable differences between either subgroup and the normal families (e.g., Mishler & Waxier, 1968—positive interpersonal expressiveness; Riskin & Faunce, 1971—affective intensity: up). In this review, these occurrences are spoken of as reflecting no reliable differences (i.e., p> .05), and this phrase should be interpreted to mean no reliable differences between experimental and control groups,

INTERACTION


procedure involving no judgments whatsoever (e.g., the number of "matches" between the rankings of a family and an individual questionnaire). Regarding affect data, the corresponding text is divided in terms of measurements assessing amount or intensity of affective expressions, positive affective expressions, and negative affective expressions. Finally, for data relevant to the domain of communication clarity and accuracy, studies are not divided beyond the major division of investigations containing schizophrenic versus nonschizophrenic disturbed families. Conflict Schizophrenic Families Quantitative process measures. Five studies have evaluated patterns of conflict in schizophrenic and control families by means of verbal frequency measures (Farina & Holzberg, 1968; Ferreira et al., 1966; Lennard et al., 1965; Mishler & Waxier, 1968; Stabenau, Turpin, Werner, & Pollin, 1965). Of nine total comparisons reported over these five studies, six did not yield significant differences between schizophrenic and controL (disturbed and/or normal) families (Farina & Holzberg, 1968—simultaneous speech and interruptions; Ferreira et al., 1966—simultaneous speech; Lennard et al., 1965—percent intrusions; Stabenau et al., 1965—overlaps and interruptions). In the remaining three comparisons, significant group differences were reported and all suggested greater frequency of interrupting behavior in normal versus schizophrenic families. First, Lennard et al. (1965) indicated that normal mothers intruded more often (median number) than schizophrenic mothers (whereas no significant differences were obtained in comparisons of fathers and children). Second, Mishler and Waxler's (1968) "attempted interruption" data differentiated normal from schizophrenic families, although the inclusion of good and poor premorbid schizophrenic groups, male and female children, and sessions with the identified patient and well sibling yielded a rather complicated set of findings. In general, however, normal families as a group and normal fathers in particular interrupted more often than good premorbid schizophrenic fam-

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ilies—findings that appeared in interactions with both male and female identified patients and in interactions with female (but not male) well siblings. Although data concerning mothers and children did not achieve statistical significance, the same patterns of normal greater than schizophrenic were reported. Third, Mishler and Waxler's (1968) "being interrupted" data were generally parallel to their attempted interruption data in indicating an ordering of normal greater than schizophrenic families, although statistical significance was less often achieved. Specifically, normal families were interrupted significantly more often than good premorbid families in interactions with male and female identified patients; and normal mothers and children were interrupted significantly more often than good premorbid mothers and children in interactions with female (but not male) identified patients. All other comparisons failed to achieve significance, but as noted above, a consistent pattern of normal greater than schizophrenic was reported by the investigators. Qualitative process measures. Four studies compared schizophrenic and control families along such rated dimensions as agreement, disagreement, failure to agree, and conflict (Cheek, 1964a, 1964b, 1965b; Farina & Holzberg, 1968; Friedman & Friedman, 1970; Lennard et al., 1965).12 Of seven comparisons reported (over four studies), significant differences between groups were not obtained in , three comparisons (Cheek, 1964a, 1964b, 1965b—agreement; Lennard et al., 1965— agreement and disagreement). In three of the remaining four comparisons, schizophrenic (poor premorbid only) fathers disagreed with their wives more often than nonschizophrenic disturbed fathers disagreed with their wives (Farina & Holzberg, 1968); schizophrenic parents (poor premorbid only) failed to agree more often than did disturbed parents (Farina & Holzberg, 1968); and schizophrenic families were judged to express 12

In each of the three articles by Cheek (1964a, 1964b, 1965b), results relevant to only one family member were reported. Since the three articles were based on exactly the same data obtained at the same point in time, the separate reports were classified as one study for each comparison.

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greater conflict than normal families (Friedman & Friedman, 1970). In the final comparison, normal fathers, mothers, and children (interacting with male or female children) almost always expressed greater disagreement than schizophrenic fathers, mothers, and children, respectively (Cheek, 1964a, 1964b, 1965b). To summarize the conflict data relevant to schizophrenic and control families, the survey of 16 comparisons indicated that 9 comparisons yielded no reliable differences between groups; 3 comparisons indicated more interrupting behavior in normal versus schizophrenic families; 3 comparisons indicated more conflict, disagreement, and failure to agree in schizophrenic versus normal families; and 1 comparison indicated more disagreement in normal versus schizophrenic families. Disturbed Nonschizophrenic Families Quantitative process measures. In the survey of studies comparing disturbed (nonschizophrenic) and control families, seven investigations employed verbal frequency measures for a total of 14 comparisons (Becker & Iwakami, 1969; Ferreira et al., 1966; Hetherington et al., 1971; Leighton et al., 1971; O'Connor & Stachowiak, 1971; Riskin & Faunce, 1970; Stabenau et al., 1965). In 6 of these comparisons, there were no reliable differences between disturbed and normal families (Becker & Iwakami, 1969—duration of simultaneous speech; Ferreira et al., 1966— duration of simultaneous speech; Riskin & Faunce, 1971—interruptions and being interrupted; Stabenau et al., 1965—overlaps per minute and interruptions per minute). In three other comparisons, normal families and/ or parents engaged in more simultaneous speech and interrupting behavior than did disturbed families and parents (Becker & Iwakami, 1969; O'Connor & Stachowiak, 1971), whereas another set of three comparisons indicated the exact opposite finding in that disturbed families and members engaged in more simultaneous speech, interruptions, and being interrupted than did normal controls (Leighton et al., 1971). The last 2 comparisons (Hetherington et al., 1971) are somewhat difficult to interpret and compare with other studies in that the reported data deal with

three groups of delinquent families and one normal control group, as well as including interactions involving male and female children. Regarding frequency of simultaneous speech, the only significant difference between normal and delinquent families is the greater frequency of simultaneous speech between fathers and daughters in psychopathic delinquent families versus normal families. Regarding frequency of interruptions, mothers interrupted fathers more often in neurotic delinquent families than in normal families when interactions included a male child; with female children, however, fathers interrupted mothers more often in normal versus neurotic delinquent families, daughters interrupted fathers more often in psychopathic delinquent families versus normal families, and daughters interrupted mothers more often in normal families than in all three types of delinquent families. In overview, Hetherington's results were almost entirely nonsignificant when interactions included male children, whereas a number of differences emerged when interactions included female children. The meaning and interpretation of the latter findings are not immediately understandable, however, and within the structure of the present review, it would seem appropriate to refer to this set of findings as "mixed"—that is, some comparisons suggested more disruptive behavior in normal than in some delinquent families, whereas other comparisons indicated the opposite ordering. Qualitative process measures. Five studies rated disturbed and normal family interaction along conflict-related dimensions for a total of nine comparisons (Becker & Iwakami, 1969; Bugental, Love, & Kaswan, 1971; Hetherington et al., 1971; Riskin & Faunce, 1970; Schulman, Shoemaker, & Moelis, 1962), and three of these comparisons yielded no significant differences between groups (Becker & Iwakami, 1969—disagreement and failure to agree; Schulman et al., 1962—disagreement). Two of the remaining six comparisons appeared in the Hetherington et al. (1971) study. First, fathers disagreed with mothers more often in neurotic delinquent versus normal families, and mothers disagreed with sons more often in normal than in neurotic delinquent families (only when interactions in-

INTERACTION


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eluded male children). Second, failure to is assessed by the similarity between individagree between parents was greater in social ual and group protocols; that is, the greater and psychopathic delinquent families than in the similarity, the greater the member's effecnormal families (only with male children), tiveness in encouraging other members to acand failure to agree between father and cept his individual answers, and the greater daughter and father and son was greater in the power or influence inferred. A concepsocial and psychopathic delinquent versus nor- tually related index of dominance is outcome mal families. Similar to the Hetherington of a game "played" by the family, in which et al. (1971) design, Riskin and Faunce's power or dominance is equated with "win(1970) study included several types of dis- ning." turbed families, as well as a normal control group. For three measures, it was reported Schizophrenic Families Outcome measures. Two studies comparing that normal families expressed more agreement and less disagreement than one of the schizophrenic and control families assessed four disturbed groups (delinquency and un- dominance by means of an outcome measure. derachievement being the major denning Ferreira and Winter (1965) reported no reli"problems" of this family type). In the final able differences between family groups in comparison, Bugental et al. (1971) reported terms of the proportion of "dictatorial decithat disturbed mothers (but not fathers) ex- sions," whereas Haley (1962), using outcome pressed significantly more conflict than nor- on a coalition game, reported an equalitarian mal mothers, as reflected in the incongruency power structure in normal families (father = in the evaluative content of different com- mother = child) and a father-dominated munication channels. structure in schizophrenic families (father > To summarize the conflict data relevant to mother = child). disturbed and control families, a survey of Quantitative process measures. Five studies 23 comparisons indicated that 9 comparisons assessed dominance by means of verbal freyielded no reliable differences between groups; quency measures such as successful interrup4 comparisons indicated more interrupting be- tions, talking time, statement length, and to havior in normal versus disturbed families; whom acts are directed (Cheek, 1964a, 1964b, 3 comparisons indicated more interrupting be- 196Sa; Farina & Holzberg, 1968; Ferreira havior in disturbed versus normal families; et al., 1966; Lennard et al., 1965; Mishler & 2 comparisons indicated mixed findings re- Waxier, 1968). Of nine total comparisons, garding group differences in interrupting be- four indicated no reliable differences between havior; and 4 comparisons generally indicated schizophrenic and control families (Farina & greater agreement, less disagreement, less fail- Holzberg, 1968—talking time; Lennard et al., ure to agree, or less channel conflict in normal 1965—number of communications; Mishler versus disturbed family groups. & Waxier, 1968—successful interruptions and being successfully interrupted—for these two Dominance measures the authors reported significant As with the various indexes of conflict, group differences only when a "well sibling" measures of dominance can be separated into was present). Although the remaining five quantitative process measures (verbal fre- comparisons reported significant differences quency measures) and qualitative process between schizophrenic and control families, measures (rater judgments of dominance and the direction of such differences was found to dominance-related dimensions). In addition, be rather inconsistent across studies. Cheek an outcome measure of dominance can be (1964a, 1964b, 1965b) noted that normal identified in terms of the relationship between sons participated more than schizophrenic a family's questionnaire responses (completed sons, that schizophrenic daughters participated as a group) and responses to the same ques- more than normal daughters, and that normal tionnaire previously completed by each mem- mothers participated more than schizophrenic ber individually. With this procedure, a mem- mothers (interacting with male or female chilber's relative dominance (power or influence) dren). Ferreira et al. (1966) observed that

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normal children talked more than schizophrenic children, although interactions containing male and female children were not analyzed separately. In seeming contrast with Cheek's results, Mishler and Waxier (1968) reported that normal daughters participated more than poor premorbid daughters and spoke in longer intervals than good premorbid daughters, whereas good premorbid fathers spoke in longer intervals than normal fathers (with male children only). For "acts directed to" data, the same investigators reported that normal fathers received more acts than schizophrenic fathers, which was largely a function of the differential rate with which schizophrenic and normal sons directed acts to fathers; and schizophrenic sons received more acts than normal sons from their parents, fathers, and mothers. Qualitative process measures. Three studies (Farina & Holzberg, 1968; Friedman & Friedman, 1970; McCord, Porta, & McCord, 1962) produced six comparisons of schizophrenic and control families in which ratings of dominance and dominance-related dimensions served as dependent variables. In two of these six comparisons, no reliable differences were obtained (Farina & Holzberg, 1968—passive acceptance; Friedman & Friedman, 1970— family power structure). In the four remaining comparisons, schizophrenic children (poor premorbid only) were found to yield more often than nonschizophrenic disturbed children (Farina & Holzberg, 1968); schizophrenic mothers were reported to control their children and to dominate their homes to a greater extent than normal mothers (McCord et al., 1962); and normal fathers were reported to take more active leadership roles in their families than were schizophrenic fathers (McCord et al., 1962). In summary, 17 comparisons of conflict patterns in schizophrenic and control families were identified, 7 of which yielded no reliable group differences. Of the 10 remaining comparisons, 1 outcome measure indicated schizophrenic fathers to be more dominant than, normal fathers; and 4 qualitative process measures indicated normal fathers, schizophrenic mothers, and normal children to be more dominant than schizophrenic fathers, normal mothers, and schizophrenic children, respectively. The

final S comparisons (based on verbal frequency measures) were inconsistent and inconclusive, alternately indicating normal members to be more dominant than schizophrenic members and schizophrenic members to be more dominant than normal members. As is subsequently discussed, these inconsistencies seem to be importantly related to cross-study differences in diagnosis of experimental groups, sex of child, and measurement techniques. Disturbed Nonschizophrenic Families Outcome measures. Of six studies comparing dominance structures in disturbed nonschizophrenic and control families by means of a revealed or unrevealed difference technique outcome measure (Bodin, 1966; Ferreira, 1963a; Ferreira & Winter, 1965; Hutchinson, 1967; O'Connor & Stachowiak, 1971; Schuham, 1970), two reported no reliable differences between groups (Ferreira & Winter, 1965; O'Connor & Stachowiak, 1971). Although the remaining four studies produced significant group differences, inspection of obtained results reveals considerable inconsistency. First, Bodin (1966) found fathers to be more influential than sons in normal families and equal to sons in disturbed families; in both groups, fathers and mothers were of equal influence and mothers were more influential than sons. Second, Schuham (1970) reported a completely equalitarian structure (father = mother = son) in disturbed families and a hierarchical structure (father > mother > son) in normal families. In the third study, Hutchinson (1967) reported quite different dominance structures between disturbed and normal families as a function of child's sex. That is, with male children, disturbed families reflected a hierarchical structure (father > mother > child), and normal families were characterized by an equalitarian structure; with female children, the opposite occurred in that disturbed families produced, an equalitarian structure and normal families produced a hierarchical structure. In the final study (Ferreira, 1963a), analyses of within-family dominance structures were not performed and the investigator only reported that children in disturbed fam-

INTERACTION


ilies were more dominant than children in normal families. Quantitative process measures. Twelve studies compared dominance patterns in disturbed and control families by means of verbal frequency measures (Becker & Iwakami, 1969; Bugental, Love, Kaswan, & April, 1972; Ferreira et al., 1966; Haley, 1967b; Hetherington et al., 1971; Hutchinson, 1967; Leighton et al., 1971; Murrell, 1971; Murrell & Stachowiak, 1967; O'Connor & Stachowiak, 1971; Riskin & Faunce, 1970; Schuham, 1972). In total, 24 comparisons were reported, 10 of which yielded no reliable differences between groups (Becker & Iwakami, 1969—talking -time, speaks first, speaks last, speaks first and last; Ferreira et al., 1966—talking time; Haley, 1967b—talking time and speeches; Murrell, 1971—acts received; Riskin & Faunce, 1970—speeches and spoken to). In 8 of the 14 comparisons which did yield significant group differences, dominance was indexed by amount of frequency of verbal activity in terms of talking time, participation rate, speech duration, and number of speeches or acts. Leighton et al. (1971) reported that normal fathers talked more and produced more speeches than disturbed fathers, whereas disturbed mothers and children talked more and produced more speeches than their normal counterparts. Paralleling this pattern, Leighton et al. also reported that the parental dyad was dominated by fathers in normal families and by mothers in disturbed families (as indexed by talking time and number of speeches). Regarding duration of speech, Leighton et al. noted that normal fathers spoke in longer intervals than disturbed fathers, disturbed mothers spoke in longer intervals than normal mothers, and disturbed mothers spoke in longer intervals than disturbed fathers—findings that parallel the same investigators' data regarding talking time and number of speeches. It should be noted, however, that speech duration did not reliably differentiate normal from disturbed children or normal fathers from normal mothers. Consistent with Leighton et al., Schuham (1972) also found that normal fathers talked more than disturbed fathers, but Schuham obtained no reliable differences in talking times of mothers and children and no reliable dif-

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ferences in number of acts for fathers, mothers, or children. Also in contrast with Leighton et al., Schuham could not reliably differentiate mothers from fathers in disturbed or normal families in terms of talking time or number of acts, although he did report that parents spoke more than children in normal families and equal to children in disturbed families and that normal mothers (but not disturbed mothers) produced more acts than children. Bugental et al. (1972) reported that fathers of distractible children and socially withdrawn children talked more than fathers of aggressive and normal children. In the Hetherington et al. (1971) study, fathers of social delinquents (males only) spoke more than normal fathers, mothers of neurotic delinquents (males only) spoke more than normal mothers, and normal children spoke more than all three types of delinquent children (males only). Finally, Hutchinson (1967) found no reliable differences in parents' participation rate across groups, but (directly contrary to Schuham) noted that fathers and mothers participated more than children in disturbed families but equal to children in normal families (male children only). In two other significant comparisons, dominance was indexed by the frequency with which family members received communications from other members. In one comparison O'Connor and Stachowiak (1971) reported that mothers were spoken to more than fathers in families with a mentally retarded child and equal to fathers in normal and "lowadjusted" families. Also, younger children were spoken to more often than older children in normal and low-adjusted families, whereas the reverse was evident in families with a mentally retarded child. In the other comparison, Murrell and Stachowiak (1967) reported that normal mothers received more acts than disturbed mothers, and older children in disturbed families received more acts than older children in normal families. Concerning within-family structure in disturbed families, Murrell and Stachowiak reported no reliable differences between parents or between either parent and the older child; in normal families, however, mothers received more acts than fathers, and both parents re-

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ceived more acts than older children and younger children. The final four comparisons (successful interruptions, speaks first, speaks last, speaks first and last) were found in the Hetherington et al. (1971) study in which three delinquent family groups were defined and contrasted with one another and with a normal control. With male children, normal husbands successfully interrupted their wives more often than neurotic delinquent husbands interrupted their wives, whereas the reverse was evident in terms of wives successfully interrupting husbands. Regarding father-child interruption patterns, normal fathers interrupted their sons more often than neurotic delinquent fathers interrupted their sons. Regarding motherchild interruption patterns, normal mothers interrupted their sons more often than psychopathic and social delinquent mothers interrupted their sons; and normal sons interrupted their mothers more often than neurotic, psychopathic, and social delinquent sons interrupted their mothers. For female children, three of the dyadic comparisons yielded no reliable differences, and the remaining three combinations produced patterns quite different from those observed with male children. For the last three comparisons, fathers of psychopathic and social delinquent sons and mothers of neurotic delinquent sons generally spoke first, last, and first and last more often than normal fathers and mothers, respectively; regarding sons, normal male children were reported to speak first and last more often than psychopathic delinquent male children. For interactions containing a female child, greatest consistency was reflected in mothers' behaviors in that mothers of neurotic delinquent daughters spoke first, last, and first and last more often than normal mothers. On the other hand, fathers of the psychopathic delinquent daughters spoke first •and first and last more often than normal fathers, although normal fathers spoke last more often than neurotic delinquent and social delinquent fathers, and normal fathers spoke first and last more often than neurotic delinquent fathers. Qualitative process measures. Six studies assessed dominance patterns in disturbed and control families by ratings of dominance or

dominance-related dimensions (Becker & Iwakami, 1969; Bugental et al., 1972; Hetherington et al., 1971; Schuham, 1970; Schulman et al., 1962; Alexander, Note 1). Of a total of 14 comparisons reported, 8 yielded no reliable differences between family groups (Becker & Iwakami, 1969—yielding-maximum, yielding-minimum, and passive acceptance; Schulman et al., 1962—parent dominance of child, parent takes over, parent directs, parent-toparent dominance; Alexander, Note 1—dominance). In 3 of the 6 comparisons yielding significant group differences, Bugental et al. (1972) reported that fathers of aggressive children were more directing than fathers of socially withdrawn or normal children; Alexander (Note 1) reported that normal fathers were less submissive than disturbed fathers; and Schuham (1970) reported that normal fathers received more support than normal mothers, whereas in disturbed families amount of support received by fathers was not reliably different from amount received by mothers. The final three comparisons (yieldingmaximum, yielding-minimim, and passive acceptance) are found in the Hetherington et al. (1971) study. Inspection of the yielding data indicates no reliable group differences for fathers, mothers, or children when the participating child is female. Interactions with male children, however, indicated that normal fathers yielded (maximum) more than fathers of social delinquents, whereas mothers from all three delinquent groups yielded more than normal mothers. For the yielding-minimum measure, fathers could not be reliably differentiated, whereas mothers of two delinquent groups yielded more than normal mothers, and normal sons yielded more than social delinquent sons. The final measure, passive acceptance, was also less discriminating for interactions containing a female versus a male child, although normal fathers reflected greater passive acceptance vis-a-vis daughters than did neurotic delinquent fathers, and mothers of psychopathic delinquent daughters reflected more passive acceptance vis-a-vis fathers than did normal mothers. With male children, normals differed from neurotic delinquent, social delinquent, neurotic and psychopathic delinquent, and neurotic and psychopathic delinquent families for passive ac-

INTERACTION IN DISTURBED AND NORMAL

ceptance involving father to mother, mother to father, mother to son, and son to mother, respectively. In summary, 44 comparisons of dominance patterns in disturbed nonschizophrenic and control families were identified, 20 of which indicated no reliable differences between groups. Although interpretation of the considerable number of significant comparisons is limited because of several important design characteristics which vary across studies, two trends may be tentatively noted. First, family power structures are more often differentiated (hierarchical versus equalitarian) in normal than in disturbed families. Although supported by the majority of significant comparisons (omitting for the moment the Hetherington et al. data), two exceptions should be noted (Hutchinson, 1967—participation rate; O'Connor & Stachowiak, 1971—acts received) as well as Hutchinson's (1967) outcome data, which suggests that the sex of the participating child may importantly qualify (or even reverse) such a conclusion. Second, the most frequently reported difference in the internal nature of normal and disturbed power structures seems to focus on the role of fathers—that is, fathers are more influential (especially vis-a-vis the child) in normal than disturbed family groups. The Hetherington et al. (1971) data, however, indicate the tentativeness of such conclusions and emphasize the need to qualify these patterns in terms of the sex of the participating child and the nature of the family's diagnostic status. The importance of these two variables (as well as other design characteristics which vary considerably across studies) in making comparisons difficult are discussed at length in the following section. Affect The third substantive domain to be reviewed is referred to as affect and includes those interaction studies concerned with amount and/or intensity of affective expressions without regard to content, general and specific positive affective expressions, and general and specific negative affective expressions. In contrast with some measures of dominance and conflict, all measures of affect are derived from judges' ratings of affect-rele-

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vant dimensions and necessarily require the judges to assess the occurrence as well as the content of communications. Because of this complete reliance on raters' judgments, this group of studies should be evaluated critically and specifically as to procedures used in training judges, interrater and intrarater reliability figures, and whether judges were "blind" as to the family's diagnosis. Schizophrenic Families Amount or intensity of affective expression. Two studies assessed schizophrenic and control families in terms of amount or intensity of affective expression without regard to the content or nature of such communication (Mishler & Waxier, 1968; Morris & Wynne, 1965). Of a total of five comparisons, one yielded no reliable differences between experimental and control families (Mishler & Waxier, 1968—total indirect affect) and two other comparisons revealed differences between schizophrenic and normal families only when the well sibling (rather than the "identified patient") was a participant in the interaction (Mishler & Waxier, 1968—interpersonal expressiveness and indirect interpersonal affect). In one or both of the latter two comparisons, poor premorbid families, fathers, mothers, and children were more expressive than their normal counterparts (only in interactions with male children). In the fourth comparison, the same investigators reported that normal families, fathers, and mothers reflected more (total) expressive behavior than their good premorbid counterparts (only in interactions with a male child). Finally, Morris and Wynne (1965) reported that judges were able to reliably discriminate between schizophrenic and disturbed family groups in terms of affective intensity. Positive affect. Four studies assessed schizophrenic and control families in terms of positive affective communications (general and specific) for a total of 12 comparisons (Cheek, 1964a, 1964b, 1965b; McCord et al., 1962; Mishler & Waxier, 1968; Winter & Ferreira, 1967). Of these 12 comparisons, 8 yielded no reliable differences between groups (Cheek, 1964a, 1964b, 1965b—solidarity, friendly, tension release; McCord et al., 1962—affection; Mishler & Waxier, 1968—expressiveness

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[positive to negative, positive interpersonal expressiveness]; Winter & Ferreira, 1967— positive affect and tension release), and one comparison revealed significant differences only in interactions containing the well sibling (Mishler & Waxier, 1968—positive indirect interpersonal affect). In the remaining comparisons, Mishler and Waxier (1968) reported normal fathers to be greater than poor premorbid and good premorbid fathers and reported normal mothers to be greater than poor premorbid mothers in terms of the degree to which indirect affective communications were positive in nature; however, it should be noted that this finding only emerged in interactions with male children. Also, these same investigators reported that normal families and mothers expressed more laughter than good premorbid families and mothers. Finally, Mishler and Waxier reported that normal families expressed more tension release behavior than good premorbid families and reported that normal fathers and mothers expressed more tension release communications than their good premorbid counterparts. Again, Mishler and Waxler's significant findings for laughter and tension release only emerged in interactions with male children. Negative affect. The final set of studies assessing schizophrenic and control families focused on negative (general and specific) affective communications. In total, five studies produced 14 comparisons, 5 of which reflected no reliable group differences (Cheek, 1964a, 1964b, 1965b—overt hostility and tension; Winter & Ferreira, 1967—antagonism, negative affect, affect [negative to.positive]). Inspection of the 9 significant comparisons indicated considerable inconsistency, however, in that negative affect was found to be more frequent in schizophrenic versus control families as often as the reverse. In particular, Friedman and Friedman (1970) reported depressive mood and anxiety-tension to be more frequently reflected by schizophrenic versus normal fathers and mothers and reported hostility to be more frequently expressed by schizophrenic versus normal mothers. In contrast, Cheek (1964a, 1964b, 196Sb) found no reliable differences between schizophrenic and normal families in hostility but did report 'that normal mothers reflected more

ego defensive behavior than schizophrenic mothers and normal children reflected more projected hostility than schizophrenic children. Winter et al. (1966), in assessing hostility themes from family Thematic Apperception Test (TAT) stories, reported that disturbed (nonschizophrenic) family groups produced more hostility (total and overt) than normal and schizophrenic family groups who could not be reliably differentiated from one another. In the final two comparisons (Mishler & Waxier, 1968), normal families were greater than good premorbid families in negative interpersonal expressiveness and normal children (males only) were greater than good premorbid sons in negative interpersonal affect. In summary, 14 of the total 31 comparisons were unable to significantly differentiate schizophrenic from control families in terms of amount or quality of affective expression, and 3 of 31 comparisons reported significant group differences only when the well sibling (and not the identified patient) was a participating member. Of the remaining 14 comparisons, 2 comparisons indicated that normal families were more expressive than schizophrenic families, and 3 comparisons indicated that normal families expressed more positive affect (general or specific) than did schizophrenic families. In nine comparisons concerned with general or specific negative affective communications, schizophrenic versus normal families were reported to express more negative affect in three comparisons, normal versus schizophrenic families were reported to express more negative affect in four comparisons, and nonschizophrenic disturbed versus schizophrenic families were reported to express more negative affect in two comparisons. In brief, results are too inconsistent to warrant a directional conclusion regarding differences in affective expressions in schizophrenic versus normal family groups. Disturbed Nonschizophrenic Families Amount or intensity of affective expression. Three of the total five comparisons (over three studies) assessing amount or intensity of affect in disturbed and control families yielded no significant group differences (Ris-

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kin & Faunce, 1970—affective intensity [up, down, up to down]). In the fourth comparison, O'Connor and Stachowiak (1971) reported more emotional communications to children in normal versus disturbed families, and in the last comparison, Bugental et al. (1972) reported that the range of evaluative communications was greater for fathers of aggressive children than for fathers of socially withdrawn, distractible, or normal children. Positive affect. Six studies produced 12 comparisons assessing disturbed and control families in terms of positive (general and specific) affective communications, 7 of these comparisons indicating no reliable group differences (Bugental et al., 1972—evaluation [positive to negative, positive extreme]; Riskin & Faunce, 1970—relationship [positive, positive to negative] and jokes; Winter & Ferreira, 1967—positive affect and tension release). In 3 of the S significant findings, Alexander reported that supportive communications from child to father and child to mother (1973b) and from father to son and mother to son (1973a) were greater in normal than disturbed families, and normal mothers expressed more affection than disturbed mothers (1970). In addition, Riskin and Faunce (1970) reported more laughter in normal families than in one of the four disturbed family groups assessed. Finally, Hetherington et al. (1971) found no group differences in the expression of warmth on the part of mothers or fathers separately, but when combined, normal parents were found to express more warmth than neurotic delinquent parents (in interactions with male children) or psychopathic delinquent parents (in interactions with female children). Negative affect. Ten studies assessed disturbed and control families in terms of negative (general and specific) affects (Alexander, 1973a, 1973b, Note 1; Bugental et al., 1972; Ferreira & Winter, 1966; Hetherington et al., 1971; Hutchinson, 1967; Riskin & Faunce, 1970; Schulman et al., 1962; Winter & Ferreira, 1967). Of a total of 16 comparisons, 6 indicated no reliable group differences (Schulman et al., 1962—criticism and hostility; Winter & Ferreira, 1967—antagonism, affect [negative and negative to positive]; Alexander, Note 1—hostility). The 3 significant com-

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parisons dealing with general negative affect indicated greater frequency or proportion of such communications in disturbed versus normal families. Specifically, Hutchinson (1967) reported negative affect to be greater in disturbed families, fathers, mothers, and children versus their normal counterparts, although sex of participating child was an important qualifier to this general finding. Riskin and Faunce (1970) also reported greater negative relationships in some disturbed versus normal families, as reflected in childto-child and child-to-parent communications. Bugental et al. (1972) reported that fathers of aggressive children manifested more negative extreme communications than did fathers of normal or socially withdrawn children. Regarding specific negative communications, all 7 significant comparisons reported disturbed families to be greater than normal controls along the various dimensions assessed. Specifically, disturbed families produced or reflected significantly more defensive communications (Alexander, 1973a, 1973b), hostility (Hetherington et al., 1971), anxious emotional involvement (Hetherington et al., 1971), rejection (Schulman et al., 1962), and total and overt hostile themes (Ferreira et al., 1966) than did normal controls. In summary, comparison of disturbed nonschizophrenic and normal families in terms of affective expression reveals the most consistent set of findings thus far. That is, 17 of 33 comparisons indicated significant group differences, and 15 of these comparisons focused on positive or negative expressions. Specifically, 5 comparisons indicated more positive affect in normal versus disturbed families, and 10 comparisons indicated more negative affect in disturbed versus normal families. Communication Clarity and Accuracy The final substantive area to be reviewed concerns the clarity and accuracy of family communications. Although several reports have employed objective, noninferential outcome measures (Alkire, 1969; Haley, 1968), the majority of investigations have relied on ratings of dimensions thought to be relevant to communication clarity. Similar to studies concerned with affective expression, then, procedures used in training judges, rater-reli-

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ability figures, and blind judgments would be particularly important considerations in evaluating this group of studies. A second characteristic of this set of data is that two studies accounted for the majority of relevant comparisons. That is, in comparisons assessing schizophrenic and normal families, Mishler and Waxler's (1968) study contributed 12 of the total 24 comparisons, whereas in the comparisons assessing disturbed nonschizophrenic and control families, Riskin and Faunce's (1970) investigation contributed 21 of the total 25 comparisons. As such, overall assessment of family differences in communication patterns are highly correlated with the results of two investigations. Schizophrenic Families Nine studies assessed schizophrenic and control families in terms of communication clarity and associated dimensions for a total of 24 comparisons. In contrast with substantial number of nonsignificant comparisons associated with other substantive domains, this set of comparisons was characterized by an abundance of significant findings. Specifically, only 5 of 24 comparisons reported no reliable group differences (Cheek, 1964a, 1964b, 1965b—acknowledgement and self-evaluation; Mishler & Waxier, 1968—total speech disturbance and incomplete phrases; Stabenau et al., 1965—pauses). In the 9 significant comparisons reported by investigators other than Mishler and Waxier, normal families were consistently found to communicate more clearly and effectively than schizophrenic families. Specifically, normal families and parents were judged higher on attention and communication adequacy than were schizophrenic families and parents (Behrens, Rosenthal, & Chodoff, 1968); normal families produced more valid and explicit information than schizophrenic families (Ferreira & Winter, 1968a); schizophrenic families were rated as more confused and produced TAT stories reflecting more vagueness and incompleteness than normal families (Friedman & Friedman, 1970); schizophrenic versus normal and nonschizophrenic disturbed children achieved fewer correct answers when instructions were communicated by parents (Haley, 1968); mothers of nonorganic schizophrenic children

were judged to reflect more "perplexity" than mothers of organic schizophrenic children and mothers of normal children (Meyers & Goldfarb, 1961); and schizophrenic families were differentiated from normal controls along the dimension of amorphous-fragmented communications (Morris & Wynne, 1965). Of the 10 significant comparisons reported by Mishler and Waxier (1968), 3 related to disruptions in communication. One of these measures (incomplete sentences) revealed group differences only when interactions contained the well sibling. A second speech disruption measure revealed consistent group differences in frequency of pauses, indicating that good premorbid families, fathers, mothers, and daughters paused more frequently than their normal family counterparts (although no reliable differences emerged in interactions with male identified patients). With the third speech disruption measure, normal fathers made greater use of repetitions than did good premorbid fathers (with male children only). The 7 remaining comparisons (which Mishler and Waxier referred to as measures of responsiveness) indicated a consistent pattern of normal families and/or members greater than schizophrenic families and/or members.13 Specifically, normal families produced more statements judged to be stimulus fragments than did poor premorbid families (only with male well siblings); normal mothers (with male or female children) and normal children (males only) produced more fragmented responses than their schizophrenic' counterparts; normal families and 13 According to Mishler and Waxier (1968), responsiveness is "to acknowledge another's behavior [and] does not require that one behaves as the other wishes but only that one show an understanding of his intentions" (p. 192) and is indexed by measures of positive acknowledgment, elliptical acknowledgment (statements lacking explicit content which are nevertheless complete, meaningful acts in terms of the common cultural understandings of them), response fragmentation (insufficient information in a response for coding degree of acknowledgment to previous statement), and stimulus fragment. In addition, responsiveness was indexed by ratings as to the "focus" of an act—the opinions of others, the experimental situation, and the personal experiences of self or others. "Both [focus on situation and personal experiences] are considered to be less responsive than comments on opinions."

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sons produced more positive acknowledgements than poor premorbid families and sons, whereas normal mothers produced more positive acknowledgements than mothers of poor premorbid daughters; and normal families (with male or- female children) and normal fathers produced more elliptical affirmations than schizophrenic families and fathers. In the final 3 comparisons, normal families, fathers, and mothers focused their responses on others' opinions more often than their poor premorbid counterparts (only in interaction with male children); normal families and mothers focused their responses on personal content more often than their poor premorbid counterparts (only in interaction with female children); and poor premorbid families, mothers, and children focused their responses on the experimental situation more often than their normal counterparts (only in interaction with female children). Interpretation of significant comparisons not reported by Mishler and Waxier (1968) can be stated quite succinctly: All nine comparisons indicated that normal families communicated more clearly and effectively than schizophrenic families. Mishler and Waxler's findings, however, were less consistent. In interpreting their "communication disruptions" data, for example, Mishler and Waxier argued convincingly that such disruptions are more likely to occur in normal than in schizophrenic families because such patterns are reflective of greater adaptability to changing situations and allow for change and the introduction of new information: This style contrasts with the rigid, ordered, almost ritualistic form of communication that requires fully completed sentences and correct construction and that provides little opportunity for spontaneous changes. (Mishler & Waxier, 1968, p. 164).

A survey of their five measures of communication disruption, however, reveals little support for this contention because only one comparison (repetitions) clearly confirmed the authors' expectations, whereas two comparisons (total speech disruption and incomplete phrases) were nonsignificant, one comparison (incomplete sentences) revealed only the expected pattern in interactions containing the well sibling, and one comparison (pauses) revealed findings opposite to those expected.

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In addition to the communication disruption measures, seven other comparisons (responsiveness) reported by these investigators also releated to the domain of communication clarity and accuracy. IB general, this set of data did suggest greater communication clarity in normal than in schizophrenic families because normal families produced more positive and elliptical acknowledgments than schizophrenic families and focused acts on others' opinions more often and on the experimental situation less often than schizophrenic families. In overview, the available data assessing communication clarity and accuracy generally suggest that schizophrenic families communicate with less clarity and accuracy than do normal families. The major exception to this conclusion, however, is that the more objective and less inferential measures of disruptions in communication reveal few reliable differences between groups. Disturbed Nonschizophrenic Families Five studies assessed disturbed and control families in terms of communication clarity and associated dimensions for a total of 25 comparisons. In contrast with the previously reviewed studies containing schizophrenic families, the great majority of relevant comparisons (18 of 25) comparing disturbed and normal families reflected no reliable group differences. As noted earlier, however, one study (Riskin & Faunce, 1970) contributed 21 of the total 25 comparisons, and the conclusion of few reliable differences between disturbed and control families was greatly influenced by the generally negative findings of this one investigation. The seven comparisons that did yield significant group differences can briefly be summarized. Alkire (1969), using a laboratory communication game to index a family member's ability to accurately communicate with and receive instructions from other members, reliably differentiated normal and disturbed groups in terms of several types of communication patterns. First, normal parents received their child's communications more accurately than did disturbed parents, and normal fathers and disturbed mothers were more accurate (that is, correct selection of designs being

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described) when spouses were communicating (sending) than the spouses were when they were communicating. Second, Alkire reported significant interactions among activity level, locus of problem, and diagnostic status (disturbed and normal), which served to qualify and specify the major finding that "the mothers in the disturbed families behaved like the fathers in the normal families" (Alkire, 1969, p. 335). Ferreira and Winter (1968a) reported normal families to communicate more valid-explicit information than disturbed and schizophrenic families, with no reliable differences observed between the two latter groups. Although Haley (1968) found no reliable differences between normal and disturbed children in number of correct answers (choices) when instructions were communicated by parents, there were significant differences reported between accuracy scores of nonschizophrenic disturbed and schizophrenic children. (Improvement scores after feedback, however, indicated no reliable differences among schizophrenic, disturbed, and normal children.) Finally, Riskin and Faunce (1970) reported the frequency of commitment, requests for commitment, and requested commitment to be greater in disturbed (especially multiproblem and delinquent families) than normal families, whereas the frequency of commitment ("highest person") was greater in normal than one of the disturbed groups ("constricted-neurotic"). DIFFICULTIES IN COMPARISON OF RESULTS ACROSS STUDIES In evaluating the various substantive findings, one must notice the considerable variability and inconsistency among the results reported by different investigators. As seen, conclusions have been tentative at best and mixed or almost entirely nonsignificant at worst. Even in those few subsets of significant comparisons which did appear internally consistent, questions can be raised regarding the generalizability of findings to other research populations, the methodological weaknesses of rater judgment measures on which such findings were based, and the failure of a considerable number of studies (within most of these subsets) to yield significant group differences. Specifically, for studies containing

schizophrenic and control families, directional consistency could be identified in only one of the four substantive domains reviewed (communication clarity and accuracy). As noted, however, the great majority of significant comparisons within this domain were not only associated with one investigation (Mishler & Waxier, 1968) but were based almost entirely on rater judgment measures. To what extent this set of findings can be replicated with different samples and with measurement procedures less vulnerable to inference and potential bias cannot be determined without further investigation. For studies containing nonschizophrenic disturbed and normal families, significant group differences were few in number for the domain of communication clarity and too inconsistent to warrant a directional conclusion for the domain of conflict. For the content area of dominance, the relevant data generally supported two tentative conclusions, although several important contradictions were noted as well as the need to qualify any directional statements in terms of the sex of the participating child and type of measurement procedures. Finally, all significant comparisons relevant to affective expression did indicate consistent differences between nonschizophrenic disturbed and normal families, although it can and should be noted that 1S of the total 29 comparisons were unable to reliably differentiate family groups in terms of general, positive, or negative affective expressions. In summary, then, it would appear that family interaction studies, although based on a potentially sound methodological strategy, have not yet isolated family patterns that reliably differentiate disturbed from normal groups. If this general conclusion is accepted, one must then inquire as to the factors associated with the observed inconsistencies and the resultant inconclusiveness characterizing the results. Beyond the "complexity of human behavior contributing to the inconclusiveness of results" (Frank, 196S, p. 198), there appear to be two methodological considerations relevant to understanding the observed inconsistencies. As noted in the first section of this review, there are a number of methodological standards which, if not attained, can render experimental and control groups noncompar-

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able. As a result, obtained group differences (or the lack thereof) can be associated with a family's diagnostic status (that is, the independent variable), differences in other variables along which experimental and control groups vary, or both. Although such considerations are primarily within-study issues, failure to institute necessary controls can lead to confounded results which in turn can render cross-study comparisons extremely hazardous, if not invalid. Even assuming that experimental and control groups are perfectly equivalent in terms of all potentially influential variables, cross-study inconsistencies can still occur if sample, design, and analytic characteristics vary from study to study. Specifically, many of the observed inconsistencies across family interaction studies may be a function of differences in diagnostic status of experimental groups, measurement techniques used in assessment of particular domains, data analysis procedures by which results are evaluated, and demographic characteristics of family groups.14 Diagnostic Status of Families In reviewing substantive findings, studies containing schizophrenic families were discussed separately from studies containing nonschizophrenic disturbed families. In so doing, it was implicitly acknowledged that such seemingly different, psychopathologies would be associated with different patterns of family interaction. As seen in the preceding review, almost every investigator also acknowledged the importance of differentiating schizophrenic from nonschizophrenic families, usually selecting one of these groups and a normal control 14 Other potentially influential variables that have varied greatly across studies include number of members in interaction (see Table 2 ) ; presence of experimenter during family discussion (Baxter et al., 1962; Becker & Iwakami, 1969; Behrens & Goldfarb, 1958; Behrens et al., 1968; Farina & Dunham, 1963; Farina & Holzberg, 1968; Friedman & Friedman, 1970; Hetherington et al., 1971; McCord et al., 1962; Meyers & Goldfarb, 1961; Morris & Wynne, 1965; O'Connor & Stachowiak, 1971; Sharan, 1966); and type of experimental task used to generate interaction (see Table 2). Regarding differences in patterns of family interaction as a function of experimental task, the reader is referred to a recent study by Jacob and Davis (1973).

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for comparison. Within each of these major divisions, however, further differentiation of schizophrenic or nonschizophrenic disturbed groups was not usually undertaken, and reference to those studies which did define and include more homogeneous subgroups clearly indicates that subgroups were often associated with quite different interaction patterns. At present, there seems to be considerable consensus that schizophrenia is not a unitary disturbance. As noted by Mishler and Waxier (1968), differences in prognosis, responses to treatment, personality characteristics, physical performance, and physiological response have been shown between schizophrenic patients classified as acute versus chronic; as process versus reactive; paranoid versus nonparanoid; hebephrenic versus catatonic versus paranoid; and as having good versus poor premorbid social adjustments, (p. 12)

If such dimensions are also associated with different patterns of family interaction, failure to define and differentiate schizophrenic family subgroups may result in a "canceling" effect by which clearly different sets of results (associated with different subsets of schizophrenic families) are combined and nullified. As a consequence, results from studies including subgroups may fail to support or may be contradictory to results from studies not including subgroups. That schizophrenic subgroups do reflect strikingly different interaction patterns and that conclusions vary greatly as a function of which schizophrenic subgroup is compared with normal controls was repeatedly demonstrated by those studies which did differentiate schizophrenic families. In particular, Mishler and Waxler's (1968) methodologically superior study, employing a variety of measures over a number of substantive domains, repeatedly reported that interaction patterns of poor and good premorbid schizophrenic families were significantly different from one another. More important than these differences between poor and good premorbid families, however, is the fact 'that it was very often found that poor or good premorbid families differed from normal controls, whereas it was relatively infrequent that both poor and good premorbid families differed from normals, in the same manner. As seen in the preceding review, other investigations

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often failed to replicate findings from the Iwakami (1969) and by Schulman et al. Mishler and Waxier study, even when mea- (1962); both of these latter two studies insurement procedures were seemingly identical. cluded disturbed groups which differed conFrom the present perspective, such studies siderably from Hetherington's delinquent (which compared normal families with an ex- sample in terms of child's age and problem tremely heterogeneous sample of schizophrenic behavior. Riskin and Faunce (1970), howfamilies) may have obtained quite different ever, included four disturbed groups and one findings if more distinct subgroups had been of these appeared rather similar to Hetheringemployed (Cheek, 1964a, 1964b, 1965b; ton's delinquent families in terms of child's age and problem behavior. As noted earlier, Winter & Ferreira, 1967). The majority of investigations concerned it was 'this group (and only this group) which with nonschizophrenic disturbed families in- was significantly different from normal concluded but one group of disturbed families, trol families on measures of agreement. Beand in many cases, the composition of these cause Hetherington observed that normal famexperimental groups was extremely hetero- ilies disagreed less and agreed more than cergeneous as to presenting problem, identified tain types of delinquent families, Riskin and patient, diagnostic status, and so on. That Faunce's significant differences between northese studies often reflected nonreplicating or mal and delinquent families in terms of agreecontradictory findings was quite evident, and ment behavior seem to provide some degree of one cannot but wonder as to the effect of such convergence between the two studies. Notsample differences on observed inconsistencies. withstanding other important differences beThe complex and multidimensional nature of tween these two studies, the importance of nonschizophrenic disturbance was recognized sample specificity and comparability (over by several investigators, however, who did dif- and above disturbed versus normal) would ferentiate disturbance into more homogeneous appear to be a limiting factor in making meansubgroups. That such efforts resulted in more . ingful comparisons among a considerable numspecific and meaningful descriptions of dys- ber of studies in the field. functional family patterns was most clearly revealed in two research projects (Goldstein, Measurement Technique Judd, Rodnick, Alkire, & Gould, 1968—difAs seen in the preceding review of substanferentiation of groups in terms of "locus of tive findings, investigators employed a variety problem" and "level of activity"; Hethering- of measurement techniques to assess the same ton et al., 1971-—differentiation of delinquent constructs. In the discussion of findings, pofamilies into unsocialized-psychopathic, neu- tential differences among measures were imrotic-disturbed, and socialized-subcultural; plicitly acknowledged by reviewing findings see also Alkire, 1969; Bugental et al., 1971, associated with seemingly homogeneous sets 1972; Goldstein et al., 1970; McPherson, of measurement techniques—that is, quantita1970). In most cases, however, results from tive process measures (verbal frequency prosuch studies were difficult to compare with cedures), qualitative process measures (rater the majority of other investigations, and I judgment procedures), and outcome meaoften tried to guess if certain identified sub- sures. That the lack of relationship among groups were similar to certain unspecified dis- measurement procedures may be an extremely turbed groups and if so, if results were con- important contributor to nonreplication of sistent. In at least one case, however, com- results across studies seems plausible indeed, parison of two investigations (both of which and at least for measures of dominance, recent differentiated subgroups) did result in a clari- empirical data strongly support this contenfication that might have been missed if either tion.18 First, Bodin (1966) reported a negastudy had included only one heterogeneous 15 To my knowledge, no reported studies have asdisturbed group. Specifically, in evaluating sessed relationships among measures of family conconflict data, differences between normal and flict, affect, or communication clarity within a direct certain delinquent families (Hetherington observation methodology^-a lack which certainly deet al., 1971) were not found by Becker and serves the attention of future investigators.

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tive correlation between two outcome measures (a coalition game and an unrevealed difference technique) for mothers and no significant correlations for fathers or for sons. Second, Alexander (Note 1) reported a negative relationship between a rater judgment measure (number of dominant statements) and an outcome measure (unrevealed differenece technique). Finally, Hadley and Jacob (1973) reported a positive and significant relationship between two quantitative process measures (successful interruptions and talking time), a nonsignificant relationship between two outcome measures (coalition game and an unrevealed difference technique), and nonsignificant relationships among process and outcome measures. As noted by Hadley (Note 2), it is likely that family power is a multilevel, if not a multidimensional, construct and that the various measurement procedures may be assessing entirely different levels or dimensions of this construct. Although several investigators have attempted to define and differentiate power measures within a logicalconceptual schema (French & Raven, 1959; Mishler & Waxier, 1968; Ryder, 1972), there have been few systematic attempts to empirically evaluate such proposals (see Hadley & Jacob's, 1973, attempt to empirically assess a proposed theoretical framework of family power.) I think that further attempts to assess relationships among measurement procedures, within a guiding conceptual schema, should receive high priority by family researchers. Without a clearer understanding of measurement relationships, meaningful comparisons across studies may be severely limited. An issue related to the association among measurement procedures concerns the relationship between verbal activity and the various quantitative process measures. Specifically, data from several investigations clearly indicate that various verbal frequency measures are significantly correlated with and affected by verbal activity (e.g., Becker & Iwakami, 1969; Hadley & Jacob, 1973; Jacob, 1974). As such, results which control for verbal activity (by using percentages, proportions, ranks, analysis of covariance, etc.) may yield conclusions at variance with results based on raw (absolute) scores. In reviewing quantita-

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tive process measures of conflict, for example, three comparisons indicated that normal families engaged in more simultaneous speech and interrupting behavior than did disturbed families, whereas another set of three comparisons indicated the exact opposite findings. Because the first set of comparisons (Becker & Iwakami, 1969; O'Connor & Stachowiak, 1971) did control for verbal activity and the second set of contradictory comparisons (Leighton et al., 1971) did not, it seems reasonable to suggest that this methodological difference may have been importantly related to observed inconsistencies. Although it was not possible to reevaluate the Leighton et al. data with verbal activity held constant, it is noteworthy that disturbed and normal members were found to differ significantly in verbal activity and that such differences were parallel to reported differences between disturbed and normal members' interruptions rates in five of the six significant comparisons. In complete agreement with Becker and Iwakami's (1969) observation, it would appear that "studies using these [verbal frequency] indices without correction for the effects of verbal activity must be interpreted cautiously" (p. 334). Type of analysis By type of analysis I do not mean to direct attention to particular statistics selected by investigators. Instead type of analysis, ,as used in the present context, refers to differences in the unit of analysis and the focus of interpretation.16 Inspection of substantive findings indicates that differences between experimental and control families have been described at the family (group) level, the dyadic level, and the individual level. That each unit provides interesting and valid data concerning differences between experimental and control families cannot be disputed. What can be argued, however, is that conclusions based on different units of analysis necessarily limit the meaningfulness of cross-study comparisons. That is, since one cannot assume correspond16

The reader is referred to Mishler and Waxler's (1968, pp. 55-79) most thoughtful discussion of these issues.

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ence between these different levels of analysis, interpretations and conclusions must be restricted and appropriate to the unit assessed. In this respect, Mishler and Waxier (1968, p. 59) noted two common interpretive fallacies that result from failure to restrict interpretations to the selected unit of analysis—an aggregative fallacy ("when motivations are imputed to individuals to interpret or account for their behavior on the basis of comparisons across groups") and a psychologistic fallacy ("an overinterpretation or overemphasis of individual psychological factors when fuller understanding requires knowledge of the group or social context of the individual's behavior"). The major point to be made in the context of this review is that comparisons of studies using different units of analysis yield noncumulative knowledge at best and erroneous conclusions at worst. The second type of analysis issue concerns focus on within-family differences versus between-family differences and the associated problems in comparing studies having these different foci. As with differences in unit of analysis, there is no argument that within and between analyses both represent legitimate sources of data but rather that results based on these different strategies are often not comparable. For example, findings which indicate differences in fathers' talking times (dominance) as a function of diagnostic status may not indicate (if true) that both disturbed and normal fathers talked significantly more than wives and children within their respective families, regardless of differences in absolute amount of talking. On the other hand, a withinfamily analysis (sometimes called a structural analysis) may indicate quite different dominance patterns in disturbed and normal groups (e.g., father > mother > child versus father = mother = child), whereas analysis of individual member behavior across groups may yield no reliable effects. Demographic Factors It was suggested earlier that one important criteria by which a study's methodological adequacy should be evaluated is demographic comparability of experimental and control families. Even assuming that groups were per-

fectly equated in all reported studies, crossstudy variation in families' demographic characteristics can still exist, and to the extent that this is true, comparisons become problematic. Although a number of demographic variables have been demonstrated to influence family interaction patterns (independent of or in interaction with a family's diagnostic status), the following discussion focuses on social class, child's age, and child's sex and emphasizes recent findings not discussed in previous reviews. That child's sex exerts a significant effect on emergent patterns of interaction has been repeatedly demonstrated in studies containing schizophrenic families (Baxter et al., 1962; Cheek, 1964a, 1964b, 196Sb; Ferreira & Winter, 1965; Mishler & Waxier, 1968) and in studies containing disturbed families (Ferreira, 1963a, 1963b; Hetherington et al., 1971; Hutchinson, 1967). As such, it was disappointing to note that the majority of reviewed studies containing male and female children summed scores across sex, a procedure which at best would increase error variance and at worst, confound results. Beyond this within-study consideration, studies which analyzed data separately so often reported different interaction patterns (as a function of the participating child's sex) that one has to question the meaning of significant (or nonsignificant) group differences associated with studies which did not perform separate analyses. For example, would Murrell and Stachowiak's^ (1967) "acts received" results have been more consistent with O'Connor and Stachowiak's (1971) "spoken to" results had the former study performed separate analyses? To what extent were Riskin and Faunce's (1970) generally nonsignificant "affect" data (17 of 21 reported comparisons being nonsignificant) a result of the considerable error variance associated with analyses of male and female children together? Did the Stabenau et al. (1965) "pause" data fail to differentiate schizophrenic from normal families and fail to parallel Mishler and Waxler's (1968) striking group differences (when the participating child was female) because the former study summed data for male and female children? Although it is impossible to provide answers to such questions because of

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other design and/cir sample differences, the necessity that future investigators perform separate analyses as a function of child's sex should be obvious. As with child's sex, a number of investigators have reported interaction patterns in disturbed and normal families to be importantly influenced by social class (Alkire, 1969; Baxter & Arthur, 1964; Becker & Iwakami, 1969) and child's age (Ferreira, 1963a, 1963b; Ferreira & Winter, 1968a; Murrell & Stachowiak, 1967). In addition, social class and child's age variables have been of continued importance to sociologists and to social and developmental psychologists in their theoretical and empirical attempts to clarify the nature of family relationships (Blood & Wolfe, 1960; Bowerman & Elder, 1964; Douvan & Adelson, 1966; Hess, 1970; Kohn, 1963; Maas, 1951; Scott, 1962; Strauss, 1967; Strodtbeck, 1958; Hess & Torney, Note 3). Although differences in social class and child's age would appear to seriously limit one's ability to make meaningful comparisons across studies, most of the empirical literature previously cited did not employ direct observation methods and/or did not systematically assess the effects of social class and child's age on family interaction patterns. In a recent study, however, these relationships were assessed systematically within a direct observation format (Jacob, 1974), and although limited to normal family triads, observed relationships were quite striking and clearly indicated the difficulties one would encounter in comparing those (reviewed) studies which differ along these dimensions. Specifically, a 2 X 2 factorial design assessed the interactions of middle- and lower-class families containing an 11- or 16year-old male child, with the four groups being carefully matched as to child's IQ, family size, parents' ages, child's birth order, and family religion. The experimental task was a modification of Bodin's (1966) unrevealed difference technique and both conflict measures (attempted interruptions/talking time and disagreement between the individually completed unrevealed difference technique protocols) and dominance measures (talking time, successful interruptions/talking time, and unrevealed difference technique outcome) were included. Of the various findings re-

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ported, the following seem most relevant to the present review: 1. Initial disagreement (unrevealed difference technique) among all family members was greater in lower-class than in middle-class families, initial disagreement between parents was greater in lower-class than in middle-class families, and agreement between parents was greater than parent-child agreement significantly more often in middle-class than in lower-class families. 2. Families with an 11-year-old expressed greater disagreement among members than did families with a 16-year-old, and fatherson initial agreement was greater in dyads with a 16-year-old than in dyads with an 11-year-old son. 3. Middle-class families talked more and successfully interrupted more than lower-class families, and both parents tended to interrupt relatively more frequently in the presence of a 16- versus an 11-year-old child. 4. On the unrevealed difference technique outcome measure of dominance, mothers' and fathers' relative influence was less and sons' relative influence was more when interactions involved a 16- versus an 11-year-old child. In middle-class families, sons' gains in influence were clearly at the expense of mothers', whereas the relative influence of middle-class fathers remained the same regardless of child's age. In contrast, sons' gains in influence in lower-class families were often associated with father's losses in influence. In overview, then, both social class status and age of child were significantly associated with various measures of conflict and dominance, and in many cases, obtained relationships were influenced considerably as a function of a Social Class X Child's Age interaction. That significant relationships were identified within the same experimental paradigm characterizing studies in this review (direct observation of three-member family groups, process and outcome measures of dominance and conflict, etc.) provides the strongest and most direct argument for the contention that variations in social class and child's age seriously limit the meaningfulness of cross-study comparisons. It is most evident for the child's age variable that the reviewed studies have varied considerably along these dimensions. Specifi-

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cally, inspection of Table 2 indicates that (a) reported mean age of participating child ranged from 8.5 years (Meyers & Goldfarb, 1961) to 27 years (Baxter et al., 1962), (b) reported age ranges were as small as 2 years (Alexander, 1973a, Note 1; Behrens & Goldfarb, 1958; Murrell, 1971) and as large as 25 years (Baxter et al., 1962), and (c) 24 of 57 studies did riot report both mean age and range figures. Regarding families' social class status, most investigators were quite careless and/or general in their descriptions ("all families were middle class", "families were predominantly middle class," or "groups were judged similar as to social class"), and it was the unusual investigator who reported mean and range figures for specific criteria such as education, occupation, and income. Reconciling reported inconsistencies in terms of crossstudy variation in social class or child's age, however, does not appear feasible for two reasons. First, specific descriptions of social class and child's age characteristics are absent in many of the reviewed studies. (As previously noted, this is especially true for social class descriptions.) Second, studies which clearly differ along one of these dimensions (especially child's age) also differ along other potentially influential variables. For example, evaluation of three seemingly comparable studies assessing disturbed and normal families by means of an unrevealed difference technique outcome measure indicates that one study included 12-year-old children (Schuham, 1970), whereas the other two studies included adolescent-age children (Bodin, 1966; Hutchinson, 1967), and therefore one might attempt to reconcile observed inconsistencies in terms of differences in child's age. Further inspection of these studies, however, indicates that in Schuham's (1970) study identified patients were defined as "prepsychotic," all families were tested in a research unit of a hospital, all families were paid for participating, and none of the identified patients had received or were receiving therapy. In Bodin's (1966) study, identified patients were defined as "delinquent," disturbed families were tested at a university clinic (whereas normal families were tested at a university department), no families were paid for participating, and some identified

patients had received or were receiving therapy. Finally, in Hutchinson's (1967) study, identified patients were defined as emotionally disturbed, all families were seen in their own homes, no families were paid for participating, and some identified patients had received or were receiving therapy. As can be seen then, not only did these three studies differ as to child's age, but there were also cross-study variations as to the diagnostic and treatment status of experimental families, the setting in which families were assessed, and the remuneration of families for their participation. That these variables can also affect emergent patterns of interaction was suggested earlier, and as such, it would seem impossible to untangle the inconsistencies among studies which differ along a number of potentially influential variables. At best, it can only be hoped that future investigators will more clearly and specifically describe sample and design characteristics and that subsequent studies will clarify the complex relationships among these variables and their effects on emergent patterns of family interaction. REFERENCE NOTES 1. Alexander, J. F. Videotaped family interaction: A systems approach. Paper presented at the meeting of the Western Psychological Association, Los Angeles, April 1970. 2. Hadley, T. Relationship among four measures of family power. Unpublished master's thesis, University of Pittsburgh, 1971. 3. Hess, R., & Torney, J. The development of basic attitudes and values toward government and citizenship during elementary school years (Pi. I. Cooperative Research Project 1078). Unpublished report to the U.S. Office of Education, University of Chicago, 1965. REFERENCES Alexander, J. F. Defensive and supportive communications in family systems. Journal of Marriage and the Family. 1973, 35, 613-617. (a) Alexander, J. F. Defensive and supportive communications in normal and deviant families. Journal of Clinical and Consulting Psychology. 1973, 40, 223-231. (b) Alkire, A. Social power and communication within the families of disturbed and nondisturbed preadolescents. Journal of Personality and Social Psychology, 1969, 13, 335-349. Altman, S. Primitive behavior in review. Science, 1965, ISO, 1440-1442. Bales, R. Personality and interpersonal behavior. New York: Holt, Rinehart & Winston, 1970. Bateson, G., Jackson, D., Haley, J., & Weakfand, J.

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