Journal of Youth and Adolescence, Vol. 7, No. 4, 1978
Family Interaction Patterns Among Families with Normal, Disturbed, and Drug-Abusing Adolescents Carol A. Gantman 1
Received March 13, 1978
The relationships between family interaction patterns and the symptomatology o f the individual family member are central to many therapeutic approaches. This study was designed to determine whether family interaction patterns differ significantly among three groups o f families defined according to the adolescent offspring's symptoms. Thirty families were evaluated in a one-hour interview while three observers behind a one-way mirror rated verbal behavior and the quality o f interaction between father, mother, and adolescent. Assessed behaviors included the ability to reach a decision, decision time, scapegoating, and doublebind messages. In addition, the quality o f the family's interaction was assessed at four different times during the interview. The results established that the three family groups did not differ demographically. A comparison o f the two disturbed family groups yielded no significant differences, with the exception o f the adolescent's presenting problem and behaviorz The normal group was significantly different from the other two groups in frequency o f scapegoating o f the adolescent and the ability to reach a decision. Additionally, the normal families displayed clearer communication, more freedom o f expression, more cooperation, and greater sensitivity among members. Several variables did not discriminate the normal group from the disturbed family groups.
INTRODUCTION
This study 2 is aimed at investigating the family's importance during adolescence by empirically establishing patterns o f family interaction in different types o f families separated by the adolescent's symptoms and behavior. 1Senior Staff Psychologist at Friends Hospital, Philadelphia, Pennsylvania. Received her Ph.D. from Bryn Mawr College. Research interests are adolescent psychopathology as it relates to family, group psychotherapy with adolescents, and use of the therapeutic milieu. 2 Research was conducted from November 1975,through February 1976. 429 0 0 4 7 - 2 8 9 1 / 7 8 / 1 2 0 0 - 0 4 2 9 $ 0 5 . 0 0 / 0 9 1978 Plenum Publishing Corporation
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Gantman
One goal was to evaluate whether drug-abusing adolescents were different from emotionally disturbed adolescents by determining if these groups' families interact in significantly different patterns. A second aim of the research was to investigate how the families of these disturbed adolescents differ in interactional patterns from families with a normal adolescent. If drug abuse is merely a manifestation of an emotional problem, we would expect the drug-abusing adolescent and his family's interactions not to differ from those of the emotionally disturbed adolescent and his family. Furthermore, these families were anticipated to interact in patterns that would be significantly different from those of families with a nonsymptomatic adolescent. The type of interaction pattern prevalent in these disturbed families could then be established empirically. It was hypothesized that the interaction styles of families with a drugabusing adolescent would not be significantly different from those of families with an emotionally disturbed adolescent. Specifically, between these two family groups no significant difference was expected in the levels of decision-making ability, scapegoating, accuracy of perceptions, freedom of expression, cooperation among members, and clarity of communications. The frequency of doublebind messages and positive communications was also predicted not to differ significantly. The second major hypothesis stated that the families with a normal adolescent would differ significantly in interaction style from the families wit h drug-abusing and emotionally disturbed adolescents. Thus, the expectation was that there would be a significant difference in the variables measured when compared according to normal versus drug-abusing and emotionally disturbed families. The variables were identical to those on which the drug-abusing and emotionally disturbed families were compared.
METHOD
Setting and Sample The study was conducted at a mental health/mental retardation center servicing a four-township area in a suburban Philadelphia, Pennsylvania, county. The structured interview with father, mother, and adolescent was conducted in a large room equipped with a one-way mirror and a sound system. All family members were informed of the mirror and the microphones and the fact that they were being observed and heard by three trained observers. Thirty families were selected from a geographic area populated predominantly by White middle- and upper-middle-class families. Appropriate families had to be intact with an adolescent offspring between the ages of 14-18. Three subsamples of families were drawn in relation to the presenting behaviors of the adolescent.
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431
Families with a Normal Adolescent
The group o f families with a normal adolescent (N = 10) constituted the control sample and represented an index of normality for this study. To be included in this subsample the adolescent had to be free of any overt signs of psychopathology and to have had no referral for treatment made since he was 12 years of age. Additionally, the adolescent was not abusing drugs, defined for purposes of this study as the absence of regular use of any drugs. Use of alcohol and marijuana had to be limited to no more than two times per week. This determination was made by a staff of drug and alcohol specialists to be a level of alcohol and marijuana use which would not interfere with the adolescent's ability to cope with the demands of his daily routine. The final inclusion criterion for this family group with a normal a d o l e s c e n t - hereafter designated as N O R was that the adolescent's parents were not in treatment at the time o f the study; nor had a recent referral been made. The families in the NOR group were volunteers from the community solicited through local schools and civic groups. Families with a Drug-A busing Adolescent
The group of families with a drug-abusing adolescent (N = 10) - hereafter designated as D A - was drawn from families with an adolescent applying for treatment at the local outpatient drug and alcohol clinic. The adolescent was identified as a drug and/or alcohol abuser, this being the major presenting problem. Abuse for the purpose of this study was defined as the individual level of substance use which inhibited the adolescent from coping with the demands of his daily routine. The adolescents were for the most part poly-drug users and utilized various drugs including marijuana, alcohol, amphetamines, barbituates, and LSD. The level o f use exceeded the two-times-per-week criterion for the normal group and resulted in the adolescent's inability to assume the responsibilities assigned to him by his school, family, and friends. These drug-abusing adolescents were not physiologically addicted, nor was the means of administration by injection. The determination regarding drug abuse was made by the referral source. The referral source was one of the following: family, a school official, the police or court system, the family physician. The parents of the adolescent were not in treatment at the time of contact with the treatment facility. Families with an Emotionally Disturbed Adolescent
The subsample of families with an emotionally disturbed adolescent (N = 10) - hereafter designated as ED - was drawn from families applying for treatment related to their emotionally disturbed adolescent. The primary present-
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ing problem was an emotional disturbance defined as any psychopathology excluding mental retardation, organic brain syndrome, or psychosis. Additionally, the adolescent was not abusing drugs, defined by the absence of any regular use of drugs and a use of alcohol and marijuana at a maximum two times a week. Again, the adolescent's parents were not in treatment at the time of the study. A preliminary analysis of the data was performed to evaluate the similarity of the family groups with respect to demographic variables. The statistical procedures yielded no significant differences among the 30 families with respect to (a) socioeconomic status; (b) ages of father, mother, and adolescent; (c) number of children in the family; and (d) adolescent's birth order position. A chi-square test performed to compare the distribution of sex of the adolescents in each of the three groups was insignificant. Furthermore, a preliminary data analysis compared the results of the male adolescents and their families to those of the female adolescents and their families in each group. The results were in no case significant. Further analyses, therefore, are reported without regard to sex of the adolescent. Data Collection
The investigator made the initial contacts with each family by telephone. Responses to a standard set of questions regarding background information of the adolescent and family determined the appropriateness and classification of the family. The father, mother, and adolescent were requested to come for the experimental interview. The ED and DA families were informed that their session would constitute the intitial step in establishing a treatment plan for their adolescent. All family members were also informed of their participation in a research study. During the one-hour interview the family was instructed to work together as a family unit on four assigned verbal tasks. They were informed that they were being listened to and observed by three professionals. The observers rated and recorded the verbal behavior of each family without knowledge of its assigned subsample. The behavioral observations included an interaction analysis, a determination of whether a family decision was made and whether any scapegoating occurred, and the tallying of the number of double-bind messages and the frequency of each member's communications. In addition, at the completion of each task, the three observers assessed the quality of the family's interaction by evaluating the amount of cooperation, member sensitivity, clarity of communication, and freedom of expression. In order to obtain these data, both in-session and posttask rating scales were utilized. Observer reliability for these scales was calculated by Pearson product-moment coefficients. The reliability coefficients ranged from 0.78 to 0.91 for the various instruments.
Family Interaction Patterns
433
Four of the tasks of the Structured Family Interview developed by Watzlawick (1966) were presented to the experimental families. Task I required a discussion of the main family problems and then a decision to be made by the family as to what the major problem was. In Task 2 the investigator requested that the family plan something the members would enjoy doing together and then come to a decision about it. Task 3 initially involved the parents' discusion of the meaning of the proverb "A rolling stone gathers no moss." During this discussion the adolescent was absent. He was recalled by the parents, who then taught him the meaning of the proverb. Task 4 asked each family member to designate in writing an area for improvement of a present member. The experimenter then read these written statements aloud, asking each member to indicate who was being described. At the conclusion of this exercise the family was thanked for its participation. The ED and DA families were informed that within one week they would be notified by a member of the staff about a subsequent appointment.
RESULTS The results of this study are presented in three major categories. The first group of statistical analyses compared the data for the DA and ED families. Seven variables were examined, and no significant differences were found between these family groups with respect to (a) referral source, (b) duration of the adolescent's problem, (c) parents' knowledge of the causes of the problem, (d) parents' perceptions of the causes, (e) difficulty with the adolescent's siblings, (f) adolescent's presenting problem, and (g) behaviors by which the problem was manifested. As expected, for the final two variables the DA families included drug abuse while the ED families did not. The second group of variables analyzed was derived from the data collected during the Structured Family Interview. Scapegoating and blame, an important characteristic of the dysfunctional family (Raymond et al., 1975), was assessed during Tasks I and 4. The results, reproduced in Table I, indicated that for Task 1 there was significantly more scapegoating of the adolescent by the fathers and mothers and by the total family of the DA and ED groups than for the NOR families. No significant difference was found between the DA and ED families. In Task 4 scapegoating was recorded when an inaccurate attribution of the problem area was made to the adolescent. Table II illustrates that this occurred significantly more often among members in the DA and ED families than in the NOR families.
434
Gantman Table I. Scapegoafing of the Adolescent in Task I a Fathers Family group
Mothers
Adolescent is problem
Other factors
Adolescent is problem
Other factors
0 8 8
10 2 2
2
8
9 9
1 1
NOR DA ED
aFathers: X~4) = 18.00, p < 0.001; mothers: •
=
15.15, p < 0.01.
Table II. Total Family Scapegoating of Adolescent (Family Problem Attributed to Adolescent) a
NOR DA ED
Problem not attributed to adolescent
Problem attributed to adolescent by One member
Two members
Three members
8 0 1
2 3 1
0 7 7
0 0 1
ax~) = 22.67; p < 0.001. When considered in its entirely Task 4 was seen as a measure o f the accuracy of perceptions o f family m e m b e r s toward each other. As predicted, the analysis o f variance established that the N O R families were significantly m o r e accurate in their perceptions ( F = 3 . 3 1 ; p < 0.05), while there was no significant difference b e t w e e n the two disturbed family groups w i t h respect to accuracy o f perceptions. Decision making was h y p o t h e s i z e d to be m o r e characteristic o f the N O R families during Tasks 1 and 2. Table III presents the results o f the chi-square analyses which supported this prediction for b o t h tasks. No difference was f o u n d b e t w e e n the DA and E D groups. It was further anticipated that the time required to make a decision w o u l d be greater for the two disturbed family groups. This statistical analysis p r o d u c e d no significant differences on either task a m o n g the three groups o f families. Table III. Decision Made: Tasks 1 and 2 Chi Squares Choices
Decision 1
Decision 2
NOR vs. DA vs. ED (df = 2) NOR vs. DA and ED (df = 1) DA vs. ED (df = 1)
5.70 b 4.80 a 1.25
8.04 a 4.48 a 3.20
ap < 0.05. bp = 0.057.
435
Family Interaction Patterns Table IV, Parents' Response When Adolescent Entered in
Task 3a
NOR DA ED
Tell proverb meaning
Ask adolescent's oPinion of meaning
1 6 6
9 4 4
ax22~ = 6.79; p < 0.05.
The third task of the Structured Family Interview, which requires an interpretation of a proverb, yields information about the process of marital and family communication. A prediction was make regarding the number of doublebind messages produced during this task. The results did not support the prediction in that the NOR families did not produce significantly fewer double-bind communications. The second portion of Task 3 required the parents to teach the proverb's meaning to the adolescent. The statistical analysis of these data presented in Table IV revealed that NOR parents consulted the adolescent significantly more often than DA and ED parents. The DA and ED parents merely told the adolescent their view of the proverb's meaning without considering his input. The third category of results pertains to the quality of the family's interaction. Using the data derived from the interaction observations, comparisons were made among family groups of the type of messages that were communicated. It was expected that NOR families would produce significantly more positive communications and significantly fewer negative communications. Two-way analyses of variance yielded the results reproduced in Table V, which support this prediction. Furthermore, NOR families were predicted to give suggestions and opinions significantly more often than the DA and ED families. The data analysis did not support this hypothesis. Further analyses illustrated no significant differences among family groups with respect to the number of silences produced. The posttask questionnaires assessed the quality of interaction following each of the four tasks. The data were analyzed for each of the four tasks and for the total interview. The results for the analyses of variance are presented in Table VI. One aspect of the family atmosphere that was evaluated was the relative amount of freedom for members to express themselves openly. The analyses of variance performed on the data established that significant differences occurred between the NOR and the two disturbed family groups (NOR versus DA and ED families) for all four tasks and for the total interview. No differences were found between the DA and ED families for freedom of expression. The amount of cooperation among family members was expected to vary by family group. As predicted the NOR families were significantly different from the DA and ED families for Tasks 1, 2, 4 and for the family total for the
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Gantman
Table V. Analysis of Variance for Positive and Negative Actions Fathers
Mothers Adolescents
Positive actions NOR 135 DA 80 ED 105 Main effects: Family group Family member Interaction effect Negative actions NOR DA ED
85 190 230
84 71 51 56 73 245 F(2, 81) = 3.50 a F(2, 81) = 1.76 F(4, 81) -- 2.78 a 104 198 184
60 75 75
Main effects: Family group F(2, 81) = 6.76 a Family member F(2, 81) = 10.62b Interaction effect F(4, 81) = 1.45
ap < 0.05. bp < 0.01. entire interview (Table VI). Again, the DA and ED families did not differ significantly. The absence of significant results for Task 3 is understandable, because the parents were required to teach the meaning of a proverb to the adolescent a task not necessarily requiring cooperative efforts. The clarity which characterized members' communication was compared among family groups for all four tasks and for the family total. The results of the analyses of variance were significant for Tasks 2 and 4 and for the family total, with the NOR families being distinct from the ED and DA families. The results for Tasks 1 and 3 did not support the prediction (Table VI). The quality of behavior of the leader for each tasks was assessed along with the other members' responses. Although it was predicted that the NOR families would be characterized by greater democracy of the leader in each task, Table VI. Analyses of Variance for Quality of Family Interactiona Freedom of expression Task 1 Task 2 Task 3 Task 4 Family total adf = 2,27. bp < 0.01. Cp< 0.05.
8.10 b 7.30 b 3.29 c 13.75 b 9.73 b
Clarity of Leader Cooperation communication democracy 7.49 b 3.97 c 2.84 6.37 b 6.59 b
2.81 6.54 b 1.59 5.84 b 5.43 b
4.89 c 2.68 0.89 0.66 -
Amount of members' activity 4.35 c 7.17 b 1.65 2.64 4.49c
Family Interaction Patterns
437 Table VII. CLhi-SquareGood-
ness-of-Fit T~st Comparing Family Grou~ on Members' Participationa Group
Chi square
NOR DA ED
4.85 14.87 b 64.02 b
a d f = 2.
bp < 0.001.
this result was obtained only for Task 1 (Table VI). In contrast were the impressive results of the analyses of the members' sensitivity to the leader. These data supported the significant differences predicted between the NOR and the disturbed family groups for Tasks 1 and 2, but not Task 3, and for the family total. No significant differences occurred between the DA and ED families. A final measure assessing the quality of family interaction was the amount of participation by each member. The results supported the prediction of more equal participation among NOR family members than among members of the DA and ED families. A goodness-of-fit test established that the NOR family members each participated approximately one-third of the time. The ED and DA family members' participation was significantly different from this model and, therefore, not approximately equal. The results are illustrated in Table VII.
DISCUSSION The results reported here clearly establish the absence of any significant differences between the ED and DA families on any of the demographic or interactional variables. The one spurious exception was, of course, the presence of drug abuse as a symptom for the DA adolescents. The NOR families were found to differ significantly from the ED and DA families on the following variables: (a) scapegoating of the adolescent; (b) accuracy of members' perceptions of each other; (c) teaching techniques on Task 3; (d) number of positive and negative communications; (e) freedom of expression; (f) cooperation; (g) clarity of communication; (h) members' sensitivity; (i) equality of participation among members. The absence of significant findings with respect to certain experimental variables required a closer examination of the hypothesized outcomes. The work of Haley (1964), Bateson et al. (1956, 1963), Bateson (1969), and Raymond et al. (1975) has clearly indicated that family disturbance can be evaluated by the presence of double-bind messages between members. The third task of the Structured Family Interview was designed to measure this phenomenon, but in this
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Gantman
study failed to produce the expected results. It became clear that the time allotted to measure double-bind messages and/or the method of evaluation were insufficient. Alternatively, for the purposes of this study, the concept of the double bind may not have been defined clearly enough to differentiate family groups. Other unexpected findings were produced from the posttask questionnaires and the instrument recording ongoing interaction. The differing nature of the assigned four tasks may have accounted for the discrepancies in results among tasks. For example, the requirements of Tasks 1 and 2 enabled the members to interact more freely; whereas Tasks 3 and 4, by nature, produced greater limitations on family members' interactions. The instrument used for the interaction analysis recorded four types of verbal behaviors. It was felt that this simplification of Bales's 12 categories (1970)to 4 produced an instrument that may have been too gross to fully capture the differences in interaction among family groups. Despite some unexpected outcomes, the results justify the conclusion that families with a drug-abusing adolescent are not significantly different from families with an emotionally disturbed adolescent on the variables assessed in the study. In sharp contrast are the numerous significant differences found between the NOR families and the DA and ED family groups. A related conclusion is that adolescent drug abuse, when viewed in terms of family dynamics, should be considered a family affair. The emotional symptoms of the DA and ED adolescents were manifested on the family level. The adolescent alone was clearly not the problem. It can be asserted, then, that the family is the medium through which pathology or dysfunction of the adolescent offspring is expressed. The power and potential of the family are further underscored by the findings that families which produced a normal adolescent interacted in patterns clearly distinguishable from families with a drug-abusing or emotionally disturbed adolescent. These conclusions clearly support the writings of Josselyn (1952), who stated that even though adolescents must gain independence from their parents, parents remain important because "[the adolescents] need their support in doing this" (p. 89). A research study by Ferreria and Winter (1968) comparing normal adolescents and their families with adolescents with diagnosed psychopathology and their families found that normal families were more able to communicate with each other. This finding is in agreement with the findings of the current study and with Burchard's claim (1972) that "it is important to realize that the use of drugs by the young population is secondary to other problems which involve the family" (p. 31). Other studies (Chein, 1964; Haastrup and Thomsen, 1972) which were performed compared families of drug-abusing and "normal" adolescents. Findings indicated that significant differences existed in the number of broken homes and the quality of role models established by parents. These conclusions suggest a need for family involvement in the treatment of adolescent psychopathology. Thus, this study corroborates Andrews's contention (1974) that the symptomatic individual is part of a dysfunctional family system and not an encapsulated problem within himself. Although this concept
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439
of family involvement has been applied to the treatment of certain emotional disorders during adolescence, the inclusion of adolescent drug abuse is recent and has not yet been fully operationalized in treatment facilities. This study also supports Hager's conclusion (1975) that "When an adolescent becomes addicted to drugs or alcohol, his particular role within the family may be critical to his addiction and to his treatment" (p. 8). A further implication of this study's findings of significant differences between the NOR and the DA and ED families is the clinical importance of understanding what constitutes normal family interaction. Along with a growing familiarity with the normal family, there should be the accompanying identification of dysfunction in other families. If research can provide clear specific data on what distinguishes a normal family, the findings can be applied to the treatment situation and to the development of meaningful therapeutic goals. There is an equally valid and compelling need to utilize these learnings in the development of effective preventive mental health services. The far-reaching effects of all these changes may eventuate in the reduction of family dysfunctions and an opportunity to provide more effective therapy for those in need.
REFERENCES
Andrews, E. E. (1974). The Emotionally Disturbed Family, Jason Aronson, New York. Bales, R. F. (1957). Interaction Process Analysis: A Method for the Study o f Small Group, Addison-Wesley,Reading, Mass. Bales, R. F. (1970). Personality and Interpersonal Behavior, Holt, Rinehart & Winston, New York. Bateson, G. (1969). Double bind-1969. Symposium on the Double Bind, American Psychological Assoc., Washington, D.C. Bateson, G., Jackson, D. D., Haley, J., and Weakland, J. H. (1956). Toward a theory of schizophrenia. Behav. Sci. 1: 251-264. Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. H. (1963). A note on the double bind - 1962. Fam. Process 2: 154-161. Blos, P. (1962). On Adolescence: A Psychoanalytic Interpretation, Free Press, New York. Burchard, J. M. (1972). Individual and collective causes of drug abuse in juveniles. Materia Medica Nordmark 24: 27-31. Chein, I., Gerald, D. L., Lee, R. S., and Rosenfeld, E. (1964). The family of the addict. In Chein, I. (ed.), The Road to H: Narcotics, Delinquency and Social Policy, Basic Books, New York. Drake, D. C. (1972). Adolescents: When mental illness attacks our young can we help them? Philadelphia lnquirer, July 23, 1972. Ferreira, A. J., and Winter, J. D. (1968). Information exchange and silence in normal and abnormal families. Fam. Process 7:251-276. Grimm, J. (1975). Delinquency rate peaks but drug use increasing. The Journal 4(June 1): 6. Haastrup, S., and Thomsen, K. (1972). The social backgrounds of young addicts as elicited in interviews with their parents. Acta Psychiatrica Scandinavia 48:146-173. Hager, M. (1975). Drug abuse: A family affair. The Journal 4 (April 1): 4. Haley, J. (1964). Research on family patterns: An instrument measure. Fam. Process 3: 41-65. Hammond, P. E. (1973). The abuse of drug information. Schl. Library J. 12: 17-21. HEW news release. (1975). Four national surveys report: Drug use continues increase. October 1.
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Josselyn, I. M. (1948). Psychosocial Development o f Children, Family Services Association of America, New York. Josselyn, I. M. (1952). The Adolescent and His World, Family Services Association of America, New York. National National Clearinghouse for Drug and Alcohol Information. (1974). Drug Abuse Prevention Report, Vol. 2, No. 1, Government Printing Office, Washington, D.C. Offer, D., and Offer, J. B. (1975). From Teenage to Young Manhood, Basic Books, New York. Raymond, M. E., Slaby, A. E., and Lieb, J. (1975). The Healing Alliance, Norton, New York. Trainor, D. (1974). Canadian drug scene deceptively quiet. The Journal 3(November 1): 4. Watzlawick, P. (1966). A structured family interview. Fam. Process 5: 256-271. Watzlawick, P. (1970). A review of the double bind theory. Faro. Process 9: 27-39. Watzlawick, P., Beavin, J., Sikorski, L., and Mecia, B. (1970). Protection and scapegoating in pathological families. Fam. Process 9: 27-39. Wurmser, L. (1972). Drug abuse: Nemesis of psychiatry, lnt. J. Psychiat. 10: 94-107. Wynne Associates (1974). A National Study of Treatment Facilities for Non-Opiate Abusers, Vols. 1-3, National Institute on Drug Abuse, Washington, D.C.
Family Interaction Patterns Among Families with Normal, Disturbed, and Drug-Abusing Adolescents Carol A. Gantman 1
Received March 13, 1978
The relationships between family interaction patterns and the symptomatology o f the individual family member are central to many therapeutic approaches. This study was designed to determine whether family interaction patterns differ significantly among three groups o f families defined according to the adolescent offspring's symptoms. Thirty families were evaluated in a one-hour interview while three observers behind a one-way mirror rated verbal behavior and the quality o f interaction between father, mother, and adolescent. Assessed behaviors included the ability to reach a decision, decision time, scapegoating, and doublebind messages. In addition, the quality o f the family's interaction was assessed at four different times during the interview. The results established that the three family groups did not differ demographically. A comparison o f the two disturbed family groups yielded no significant differences, with the exception o f the adolescent's presenting problem and behaviorz The normal group was significantly different from the other two groups in frequency o f scapegoating o f the adolescent and the ability to reach a decision. Additionally, the normal families displayed clearer communication, more freedom o f expression, more cooperation, and greater sensitivity among members. Several variables did not discriminate the normal group from the disturbed family groups.
INTRODUCTION
This study 2 is aimed at investigating the family's importance during adolescence by empirically establishing patterns o f family interaction in different types o f families separated by the adolescent's symptoms and behavior. 1Senior Staff Psychologist at Friends Hospital, Philadelphia, Pennsylvania. Received her Ph.D. from Bryn Mawr College. Research interests are adolescent psychopathology as it relates to family, group psychotherapy with adolescents, and use of the therapeutic milieu. 2 Research was conducted from November 1975,through February 1976. 429 0 0 4 7 - 2 8 9 1 / 7 8 / 1 2 0 0 - 0 4 2 9 $ 0 5 . 0 0 / 0 9 1978 Plenum Publishing Corporation
430
Gantman
One goal was to evaluate whether drug-abusing adolescents were different from emotionally disturbed adolescents by determining if these groups' families interact in significantly different patterns. A second aim of the research was to investigate how the families of these disturbed adolescents differ in interactional patterns from families with a normal adolescent. If drug abuse is merely a manifestation of an emotional problem, we would expect the drug-abusing adolescent and his family's interactions not to differ from those of the emotionally disturbed adolescent and his family. Furthermore, these families were anticipated to interact in patterns that would be significantly different from those of families with a nonsymptomatic adolescent. The type of interaction pattern prevalent in these disturbed families could then be established empirically. It was hypothesized that the interaction styles of families with a drugabusing adolescent would not be significantly different from those of families with an emotionally disturbed adolescent. Specifically, between these two family groups no significant difference was expected in the levels of decision-making ability, scapegoating, accuracy of perceptions, freedom of expression, cooperation among members, and clarity of communications. The frequency of doublebind messages and positive communications was also predicted not to differ significantly. The second major hypothesis stated that the families with a normal adolescent would differ significantly in interaction style from the families wit h drug-abusing and emotionally disturbed adolescents. Thus, the expectation was that there would be a significant difference in the variables measured when compared according to normal versus drug-abusing and emotionally disturbed families. The variables were identical to those on which the drug-abusing and emotionally disturbed families were compared.
METHOD
Setting and Sample The study was conducted at a mental health/mental retardation center servicing a four-township area in a suburban Philadelphia, Pennsylvania, county. The structured interview with father, mother, and adolescent was conducted in a large room equipped with a one-way mirror and a sound system. All family members were informed of the mirror and the microphones and the fact that they were being observed and heard by three trained observers. Thirty families were selected from a geographic area populated predominantly by White middle- and upper-middle-class families. Appropriate families had to be intact with an adolescent offspring between the ages of 14-18. Three subsamples of families were drawn in relation to the presenting behaviors of the adolescent.
Family Interaction Patterns
431
Families with a Normal Adolescent
The group o f families with a normal adolescent (N = 10) constituted the control sample and represented an index of normality for this study. To be included in this subsample the adolescent had to be free of any overt signs of psychopathology and to have had no referral for treatment made since he was 12 years of age. Additionally, the adolescent was not abusing drugs, defined for purposes of this study as the absence of regular use of any drugs. Use of alcohol and marijuana had to be limited to no more than two times per week. This determination was made by a staff of drug and alcohol specialists to be a level of alcohol and marijuana use which would not interfere with the adolescent's ability to cope with the demands of his daily routine. The final inclusion criterion for this family group with a normal a d o l e s c e n t - hereafter designated as N O R was that the adolescent's parents were not in treatment at the time o f the study; nor had a recent referral been made. The families in the NOR group were volunteers from the community solicited through local schools and civic groups. Families with a Drug-A busing Adolescent
The group of families with a drug-abusing adolescent (N = 10) - hereafter designated as D A - was drawn from families with an adolescent applying for treatment at the local outpatient drug and alcohol clinic. The adolescent was identified as a drug and/or alcohol abuser, this being the major presenting problem. Abuse for the purpose of this study was defined as the individual level of substance use which inhibited the adolescent from coping with the demands of his daily routine. The adolescents were for the most part poly-drug users and utilized various drugs including marijuana, alcohol, amphetamines, barbituates, and LSD. The level o f use exceeded the two-times-per-week criterion for the normal group and resulted in the adolescent's inability to assume the responsibilities assigned to him by his school, family, and friends. These drug-abusing adolescents were not physiologically addicted, nor was the means of administration by injection. The determination regarding drug abuse was made by the referral source. The referral source was one of the following: family, a school official, the police or court system, the family physician. The parents of the adolescent were not in treatment at the time of contact with the treatment facility. Families with an Emotionally Disturbed Adolescent
The subsample of families with an emotionally disturbed adolescent (N = 10) - hereafter designated as ED - was drawn from families applying for treatment related to their emotionally disturbed adolescent. The primary present-
432
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ing problem was an emotional disturbance defined as any psychopathology excluding mental retardation, organic brain syndrome, or psychosis. Additionally, the adolescent was not abusing drugs, defined by the absence of any regular use of drugs and a use of alcohol and marijuana at a maximum two times a week. Again, the adolescent's parents were not in treatment at the time of the study. A preliminary analysis of the data was performed to evaluate the similarity of the family groups with respect to demographic variables. The statistical procedures yielded no significant differences among the 30 families with respect to (a) socioeconomic status; (b) ages of father, mother, and adolescent; (c) number of children in the family; and (d) adolescent's birth order position. A chi-square test performed to compare the distribution of sex of the adolescents in each of the three groups was insignificant. Furthermore, a preliminary data analysis compared the results of the male adolescents and their families to those of the female adolescents and their families in each group. The results were in no case significant. Further analyses, therefore, are reported without regard to sex of the adolescent. Data Collection
The investigator made the initial contacts with each family by telephone. Responses to a standard set of questions regarding background information of the adolescent and family determined the appropriateness and classification of the family. The father, mother, and adolescent were requested to come for the experimental interview. The ED and DA families were informed that their session would constitute the intitial step in establishing a treatment plan for their adolescent. All family members were also informed of their participation in a research study. During the one-hour interview the family was instructed to work together as a family unit on four assigned verbal tasks. They were informed that they were being listened to and observed by three professionals. The observers rated and recorded the verbal behavior of each family without knowledge of its assigned subsample. The behavioral observations included an interaction analysis, a determination of whether a family decision was made and whether any scapegoating occurred, and the tallying of the number of double-bind messages and the frequency of each member's communications. In addition, at the completion of each task, the three observers assessed the quality of the family's interaction by evaluating the amount of cooperation, member sensitivity, clarity of communication, and freedom of expression. In order to obtain these data, both in-session and posttask rating scales were utilized. Observer reliability for these scales was calculated by Pearson product-moment coefficients. The reliability coefficients ranged from 0.78 to 0.91 for the various instruments.
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433
Four of the tasks of the Structured Family Interview developed by Watzlawick (1966) were presented to the experimental families. Task I required a discussion of the main family problems and then a decision to be made by the family as to what the major problem was. In Task 2 the investigator requested that the family plan something the members would enjoy doing together and then come to a decision about it. Task 3 initially involved the parents' discusion of the meaning of the proverb "A rolling stone gathers no moss." During this discussion the adolescent was absent. He was recalled by the parents, who then taught him the meaning of the proverb. Task 4 asked each family member to designate in writing an area for improvement of a present member. The experimenter then read these written statements aloud, asking each member to indicate who was being described. At the conclusion of this exercise the family was thanked for its participation. The ED and DA families were informed that within one week they would be notified by a member of the staff about a subsequent appointment.
RESULTS The results of this study are presented in three major categories. The first group of statistical analyses compared the data for the DA and ED families. Seven variables were examined, and no significant differences were found between these family groups with respect to (a) referral source, (b) duration of the adolescent's problem, (c) parents' knowledge of the causes of the problem, (d) parents' perceptions of the causes, (e) difficulty with the adolescent's siblings, (f) adolescent's presenting problem, and (g) behaviors by which the problem was manifested. As expected, for the final two variables the DA families included drug abuse while the ED families did not. The second group of variables analyzed was derived from the data collected during the Structured Family Interview. Scapegoating and blame, an important characteristic of the dysfunctional family (Raymond et al., 1975), was assessed during Tasks I and 4. The results, reproduced in Table I, indicated that for Task 1 there was significantly more scapegoating of the adolescent by the fathers and mothers and by the total family of the DA and ED groups than for the NOR families. No significant difference was found between the DA and ED families. In Task 4 scapegoating was recorded when an inaccurate attribution of the problem area was made to the adolescent. Table II illustrates that this occurred significantly more often among members in the DA and ED families than in the NOR families.
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Mothers
Adolescent is problem
Other factors
Adolescent is problem
Other factors
0 8 8
10 2 2
2
8
9 9
1 1
NOR DA ED
aFathers: X~4) = 18.00, p < 0.001; mothers: •
=
15.15, p < 0.01.
Table II. Total Family Scapegoating of Adolescent (Family Problem Attributed to Adolescent) a
NOR DA ED
Problem not attributed to adolescent
Problem attributed to adolescent by One member
Two members
Three members
8 0 1
2 3 1
0 7 7
0 0 1
ax~) = 22.67; p < 0.001. When considered in its entirely Task 4 was seen as a measure o f the accuracy of perceptions o f family m e m b e r s toward each other. As predicted, the analysis o f variance established that the N O R families were significantly m o r e accurate in their perceptions ( F = 3 . 3 1 ; p < 0.05), while there was no significant difference b e t w e e n the two disturbed family groups w i t h respect to accuracy o f perceptions. Decision making was h y p o t h e s i z e d to be m o r e characteristic o f the N O R families during Tasks 1 and 2. Table III presents the results o f the chi-square analyses which supported this prediction for b o t h tasks. No difference was f o u n d b e t w e e n the DA and E D groups. It was further anticipated that the time required to make a decision w o u l d be greater for the two disturbed family groups. This statistical analysis p r o d u c e d no significant differences on either task a m o n g the three groups o f families. Table III. Decision Made: Tasks 1 and 2 Chi Squares Choices
Decision 1
Decision 2
NOR vs. DA vs. ED (df = 2) NOR vs. DA and ED (df = 1) DA vs. ED (df = 1)
5.70 b 4.80 a 1.25
8.04 a 4.48 a 3.20
ap < 0.05. bp = 0.057.
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Family Interaction Patterns Table IV, Parents' Response When Adolescent Entered in
Task 3a
NOR DA ED
Tell proverb meaning
Ask adolescent's oPinion of meaning
1 6 6
9 4 4
ax22~ = 6.79; p < 0.05.
The third task of the Structured Family Interview, which requires an interpretation of a proverb, yields information about the process of marital and family communication. A prediction was make regarding the number of doublebind messages produced during this task. The results did not support the prediction in that the NOR families did not produce significantly fewer double-bind communications. The second portion of Task 3 required the parents to teach the proverb's meaning to the adolescent. The statistical analysis of these data presented in Table IV revealed that NOR parents consulted the adolescent significantly more often than DA and ED parents. The DA and ED parents merely told the adolescent their view of the proverb's meaning without considering his input. The third category of results pertains to the quality of the family's interaction. Using the data derived from the interaction observations, comparisons were made among family groups of the type of messages that were communicated. It was expected that NOR families would produce significantly more positive communications and significantly fewer negative communications. Two-way analyses of variance yielded the results reproduced in Table V, which support this prediction. Furthermore, NOR families were predicted to give suggestions and opinions significantly more often than the DA and ED families. The data analysis did not support this hypothesis. Further analyses illustrated no significant differences among family groups with respect to the number of silences produced. The posttask questionnaires assessed the quality of interaction following each of the four tasks. The data were analyzed for each of the four tasks and for the total interview. The results for the analyses of variance are presented in Table VI. One aspect of the family atmosphere that was evaluated was the relative amount of freedom for members to express themselves openly. The analyses of variance performed on the data established that significant differences occurred between the NOR and the two disturbed family groups (NOR versus DA and ED families) for all four tasks and for the total interview. No differences were found between the DA and ED families for freedom of expression. The amount of cooperation among family members was expected to vary by family group. As predicted the NOR families were significantly different from the DA and ED families for Tasks 1, 2, 4 and for the family total for the
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Table V. Analysis of Variance for Positive and Negative Actions Fathers
Mothers Adolescents
Positive actions NOR 135 DA 80 ED 105 Main effects: Family group Family member Interaction effect Negative actions NOR DA ED
85 190 230
84 71 51 56 73 245 F(2, 81) = 3.50 a F(2, 81) = 1.76 F(4, 81) -- 2.78 a 104 198 184
60 75 75
Main effects: Family group F(2, 81) = 6.76 a Family member F(2, 81) = 10.62b Interaction effect F(4, 81) = 1.45
ap < 0.05. bp < 0.01. entire interview (Table VI). Again, the DA and ED families did not differ significantly. The absence of significant results for Task 3 is understandable, because the parents were required to teach the meaning of a proverb to the adolescent a task not necessarily requiring cooperative efforts. The clarity which characterized members' communication was compared among family groups for all four tasks and for the family total. The results of the analyses of variance were significant for Tasks 2 and 4 and for the family total, with the NOR families being distinct from the ED and DA families. The results for Tasks 1 and 3 did not support the prediction (Table VI). The quality of behavior of the leader for each tasks was assessed along with the other members' responses. Although it was predicted that the NOR families would be characterized by greater democracy of the leader in each task, Table VI. Analyses of Variance for Quality of Family Interactiona Freedom of expression Task 1 Task 2 Task 3 Task 4 Family total adf = 2,27. bp < 0.01. Cp< 0.05.
8.10 b 7.30 b 3.29 c 13.75 b 9.73 b
Clarity of Leader Cooperation communication democracy 7.49 b 3.97 c 2.84 6.37 b 6.59 b
2.81 6.54 b 1.59 5.84 b 5.43 b
4.89 c 2.68 0.89 0.66 -
Amount of members' activity 4.35 c 7.17 b 1.65 2.64 4.49c
Family Interaction Patterns
437 Table VII. CLhi-SquareGood-
ness-of-Fit T~st Comparing Family Grou~ on Members' Participationa Group
Chi square
NOR DA ED
4.85 14.87 b 64.02 b
a d f = 2.
bp < 0.001.
this result was obtained only for Task 1 (Table VI). In contrast were the impressive results of the analyses of the members' sensitivity to the leader. These data supported the significant differences predicted between the NOR and the disturbed family groups for Tasks 1 and 2, but not Task 3, and for the family total. No significant differences occurred between the DA and ED families. A final measure assessing the quality of family interaction was the amount of participation by each member. The results supported the prediction of more equal participation among NOR family members than among members of the DA and ED families. A goodness-of-fit test established that the NOR family members each participated approximately one-third of the time. The ED and DA family members' participation was significantly different from this model and, therefore, not approximately equal. The results are illustrated in Table VII.
DISCUSSION The results reported here clearly establish the absence of any significant differences between the ED and DA families on any of the demographic or interactional variables. The one spurious exception was, of course, the presence of drug abuse as a symptom for the DA adolescents. The NOR families were found to differ significantly from the ED and DA families on the following variables: (a) scapegoating of the adolescent; (b) accuracy of members' perceptions of each other; (c) teaching techniques on Task 3; (d) number of positive and negative communications; (e) freedom of expression; (f) cooperation; (g) clarity of communication; (h) members' sensitivity; (i) equality of participation among members. The absence of significant findings with respect to certain experimental variables required a closer examination of the hypothesized outcomes. The work of Haley (1964), Bateson et al. (1956, 1963), Bateson (1969), and Raymond et al. (1975) has clearly indicated that family disturbance can be evaluated by the presence of double-bind messages between members. The third task of the Structured Family Interview was designed to measure this phenomenon, but in this
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study failed to produce the expected results. It became clear that the time allotted to measure double-bind messages and/or the method of evaluation were insufficient. Alternatively, for the purposes of this study, the concept of the double bind may not have been defined clearly enough to differentiate family groups. Other unexpected findings were produced from the posttask questionnaires and the instrument recording ongoing interaction. The differing nature of the assigned four tasks may have accounted for the discrepancies in results among tasks. For example, the requirements of Tasks 1 and 2 enabled the members to interact more freely; whereas Tasks 3 and 4, by nature, produced greater limitations on family members' interactions. The instrument used for the interaction analysis recorded four types of verbal behaviors. It was felt that this simplification of Bales's 12 categories (1970)to 4 produced an instrument that may have been too gross to fully capture the differences in interaction among family groups. Despite some unexpected outcomes, the results justify the conclusion that families with a drug-abusing adolescent are not significantly different from families with an emotionally disturbed adolescent on the variables assessed in the study. In sharp contrast are the numerous significant differences found between the NOR families and the DA and ED family groups. A related conclusion is that adolescent drug abuse, when viewed in terms of family dynamics, should be considered a family affair. The emotional symptoms of the DA and ED adolescents were manifested on the family level. The adolescent alone was clearly not the problem. It can be asserted, then, that the family is the medium through which pathology or dysfunction of the adolescent offspring is expressed. The power and potential of the family are further underscored by the findings that families which produced a normal adolescent interacted in patterns clearly distinguishable from families with a drug-abusing or emotionally disturbed adolescent. These conclusions clearly support the writings of Josselyn (1952), who stated that even though adolescents must gain independence from their parents, parents remain important because "[the adolescents] need their support in doing this" (p. 89). A research study by Ferreria and Winter (1968) comparing normal adolescents and their families with adolescents with diagnosed psychopathology and their families found that normal families were more able to communicate with each other. This finding is in agreement with the findings of the current study and with Burchard's claim (1972) that "it is important to realize that the use of drugs by the young population is secondary to other problems which involve the family" (p. 31). Other studies (Chein, 1964; Haastrup and Thomsen, 1972) which were performed compared families of drug-abusing and "normal" adolescents. Findings indicated that significant differences existed in the number of broken homes and the quality of role models established by parents. These conclusions suggest a need for family involvement in the treatment of adolescent psychopathology. Thus, this study corroborates Andrews's contention (1974) that the symptomatic individual is part of a dysfunctional family system and not an encapsulated problem within himself. Although this concept
Family Interaction Patterns
439
of family involvement has been applied to the treatment of certain emotional disorders during adolescence, the inclusion of adolescent drug abuse is recent and has not yet been fully operationalized in treatment facilities. This study also supports Hager's conclusion (1975) that "When an adolescent becomes addicted to drugs or alcohol, his particular role within the family may be critical to his addiction and to his treatment" (p. 8). A further implication of this study's findings of significant differences between the NOR and the DA and ED families is the clinical importance of understanding what constitutes normal family interaction. Along with a growing familiarity with the normal family, there should be the accompanying identification of dysfunction in other families. If research can provide clear specific data on what distinguishes a normal family, the findings can be applied to the treatment situation and to the development of meaningful therapeutic goals. There is an equally valid and compelling need to utilize these learnings in the development of effective preventive mental health services. The far-reaching effects of all these changes may eventuate in the reduction of family dysfunctions and an opportunity to provide more effective therapy for those in need.
REFERENCES
Andrews, E. E. (1974). The Emotionally Disturbed Family, Jason Aronson, New York. Bales, R. F. (1957). Interaction Process Analysis: A Method for the Study o f Small Group, Addison-Wesley,Reading, Mass. Bales, R. F. (1970). Personality and Interpersonal Behavior, Holt, Rinehart & Winston, New York. Bateson, G. (1969). Double bind-1969. Symposium on the Double Bind, American Psychological Assoc., Washington, D.C. Bateson, G., Jackson, D. D., Haley, J., and Weakland, J. H. (1956). Toward a theory of schizophrenia. Behav. Sci. 1: 251-264. Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. H. (1963). A note on the double bind - 1962. Fam. Process 2: 154-161. Blos, P. (1962). On Adolescence: A Psychoanalytic Interpretation, Free Press, New York. Burchard, J. M. (1972). Individual and collective causes of drug abuse in juveniles. Materia Medica Nordmark 24: 27-31. Chein, I., Gerald, D. L., Lee, R. S., and Rosenfeld, E. (1964). The family of the addict. In Chein, I. (ed.), The Road to H: Narcotics, Delinquency and Social Policy, Basic Books, New York. Drake, D. C. (1972). Adolescents: When mental illness attacks our young can we help them? Philadelphia lnquirer, July 23, 1972. Ferreira, A. J., and Winter, J. D. (1968). Information exchange and silence in normal and abnormal families. Fam. Process 7:251-276. Grimm, J. (1975). Delinquency rate peaks but drug use increasing. The Journal 4(June 1): 6. Haastrup, S., and Thomsen, K. (1972). The social backgrounds of young addicts as elicited in interviews with their parents. Acta Psychiatrica Scandinavia 48:146-173. Hager, M. (1975). Drug abuse: A family affair. The Journal 4 (April 1): 4. Haley, J. (1964). Research on family patterns: An instrument measure. Fam. Process 3: 41-65. Hammond, P. E. (1973). The abuse of drug information. Schl. Library J. 12: 17-21. HEW news release. (1975). Four national surveys report: Drug use continues increase. October 1.
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Josselyn, I. M. (1948). Psychosocial Development o f Children, Family Services Association of America, New York. Josselyn, I. M. (1952). The Adolescent and His World, Family Services Association of America, New York. National National Clearinghouse for Drug and Alcohol Information. (1974). Drug Abuse Prevention Report, Vol. 2, No. 1, Government Printing Office, Washington, D.C. Offer, D., and Offer, J. B. (1975). From Teenage to Young Manhood, Basic Books, New York. Raymond, M. E., Slaby, A. E., and Lieb, J. (1975). The Healing Alliance, Norton, New York. Trainor, D. (1974). Canadian drug scene deceptively quiet. The Journal 3(November 1): 4. Watzlawick, P. (1966). A structured family interview. Fam. Process 5: 256-271. Watzlawick, P. (1970). A review of the double bind theory. Faro. Process 9: 27-39. Watzlawick, P., Beavin, J., Sikorski, L., and Mecia, B. (1970). Protection and scapegoating in pathological families. Fam. Process 9: 27-39. Wurmser, L. (1972). Drug abuse: Nemesis of psychiatry, lnt. J. Psychiat. 10: 94-107. Wynne Associates (1974). A National Study of Treatment Facilities for Non-Opiate Abusers, Vols. 1-3, National Institute on Drug Abuse, Washington, D.C.
