Triaxial Family Classification A Proposal

Wen-Shing Tseng, M.D. and John F. McDermott, Jr., M.D.

Abstract. A triaxial family classification system is proposed. The first axis concerns family development and categorizes family dysfunction at different stages of family development. The second axis refers to family member interaction and disorders are divided by marital, parent-child. and sibling subsystems. The third axis focuses on the family group as a system and its possible dysfunction as a whole.

In spite of the increasing realization that the family plays a significant role in creating or maintaining childhood psychopathology, and the enthusiasm among family therapists in developing new techniques and strategies for treating families during the past two decades, no commonly accepted system of diagnostic classification has emerged which could comprehensively categorize the various family dysfunctions. Some family therapists purposely avoid classification as ifit were artificial and smacked of "labeling." We believe, however, that there is an order to problems which exists inherently among them. Our task is to try to seek out that order and utilize it. One significant sign that the field is ready for such an undertaking is a recent editorial in Family Process by its editor, Donald Bloch, who states, "The development of a working typology of families has long been the dream of our field .... It may be that this effort, imperfect and flawed as it inevitably would be, should forge ahead now" (p. 511). Child psychiatrists have also recognized "the need for child psychiatry to develop a theoretical frame of reference for small social systems into which clinical experience with families can be fit" (Rollins et al., 1973, p. 529f.).

Dr. Tseng is Professor, and Dr. Mclrermou is Professor and Chairman. Department of Psychiatry, University of Hawaii. School of Medicine (/356 l.usiiana Street, Honolulu, Hawaii 96813), where reprint! may be requested. This paper was presented at the VI World Congress of Psychiatry in Honolulu, September 1977. 0002-713RI7!l/180 1-022 SOl.7R c I!l7!l American Academy of Child Psychiatry.

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Triaxial Family Classification

23

The concept of famil y in volves a complicated biopsychosocial organization with multiple dimensions of functions. A famil y is not merely an aggregate of related yet separate individuals ; it is a matrix of a special group with a special bond to live together and which has the potential to develop, grow , and contract. As a matrix, a famil y is involved in the functions of communication, role division , and transactions. Family life can be conceptualized from several points of view, e.g., psychodynamic or psychosocial. Heretofore, because of the complexity of the approaches to family life, it has not been possible to develop a classification which would systematically categorize fun ctions and dysfunctions associated with the family because of the differing points of view regarding important dimensions or because of the early tendency to dismiss or bypass diagnosis as antithetical to the family therapy movement. Ackerman and Behrens (1956) described seven deviant family groups. They primarily concerned themselves with the psychosocial aspects of the family-how a family as a unique social unit integrates with its community, and the internal integration of the family. Voiland and Buell (1961) later suggested four types of family pathology: perfectionistic, inadequate, egocentric, and unsocial. They focused on the ps ychopathology of the parents and ways in which the individual character of the family head may mold the functioning pattern of a family. By distinguishing various types of family psychological survival patterns and correlating these with the symptomatology of the family members, Gehrke and Kirschenbaum (1967) described the repressive, the delinquent, and the suicidal family . Goldstein et al. (1968) have tried to categorize the family according to the problems of the identified adolescents in the family, such as aggressiveantisocial, or passive-negative family . Using the three dimensions of induced "morphogenesis" (growth and change), consensual "morphostasis" (stability and solidarity) and forced "morphostasis," in describing families, with a low and a

high value for each dimension, Wertheim (1973) systematically deduced eight typologies of family systems. In 1974, Richter presented the concept of "family symptom neurosis" and "family character neurosis." For the latter, he described subtypes of anxiety-neurotic family, paranoid family, and hysterical family. Tseng et al. (1976) have proposed a system for family diagnosis and classification based on three sources of information , namely , developmental history of the family, present "mental status" of the family , and outcome of separation of the identified child patient

24

Wen-Shing Tseng and John F. McDermott, Jr.

from the rest of the family . On the basis of such information, a problem focus is identified for treatment purposes. Six types of family disorders are conceptualized for therapeutic purposes: child-reactive, parent-reactive, marital-reactive, unresolved triangular, special theme, and pan pathological families. Fisher (1977), following an extensive review of various systems of family classifications, incorporated all the described family typologies into six family clusters: constricted, internalized, objectfocused, impulsive, childlike, and chaotic family types. Hill and Hansen (1960) identified five conceptual frameworks: the interactional, the structure-function, the situational, the institutional, and the developmental approach. Anthony (1973) listed the individual, the transactional, and the developmental positions in regard to family process. Howells (1971) referred to: the individual, the relationship, the group properties, the material circumstances, and the family-community interactional dimensions. Apparently, the single dimension approach is not comprehensive enough to include the complex nature of either normal or pathological families, and a multidimensional approach is considered desirable.

Numerous students of the family have explored it from the developmental point of view (Lidz, 1970; Scherz, 1971; Solomon, 1973). Even though there are differences in defining the stages of development, most utilize the number and position of children and role changes of parents as basic criteria to formulate the stage of family development (Hill, 1970). Although the possible relationship between stages of family development and the appearance of symptoms in a family member or members has been studied (Hadley et al., 1974), the relationship between clinical psychopathology within the framework of family development is poorly understood and the literature seems to reflect this. The focus on the "sick" member of the family and the interpersonal transactions of family subsystems is by far the most common approach utilized in the field of clinical practice (Byassee and Murrell, 1975). The well-described formulation (Bieber et al., 1962) of a close, binding intimate mother and detached father related to male homosexuality is one example (although a controversial one) of such an approach. And while most students of the family conceptualize family problems as an outgrowth of marital or parentchild interactional dysfunction, the sibling subsystem should not be neglected (Bank and Kahn, 1976). Many clinical theories of family pathology approach the problem

Triaxial Family Classification

25

through one of its sick members, often the child (Hassan, 1974; Hetherington and Martin, 1972; Jenkins, 1968; Stabenau et aI., 1965; Waxler and Mishler, 1971). For example, in relation to the schizophrenic patient, Lidz et al. (1957) described the "skewed" and "schism" family; Wynne et al. (1958), the pseudomutually communicating family; and Bateson et al. (1956), the double-bind relations of parent-child interaction. The family background is described in relation to other individual psychopathology, such as obsessive disorders (Adams, 1972), school phobia (Crumley, 1974; Waldron et aI., 1975), psychosomatic disorders (Meissner, 1974; Wold, 1973), and conduct disorders (Hetherington et aI., 1971; Koller, 1971; Singer, 1974). Nevertheless, the best system to investigate the relationship between family and individual pathology is yet to be generally accepted. In spite of these efforts, most of the family classifications do not seem sufficiently comprehensive for clinical, much less research, usage because they tend to identify a single aspect of family functioning. The number of family typologies proposed is relatively small to include the complexity of family life. A useful classification system should meet the following requirements: (a) the framework for classification is comprehensive, systematic, and inclusive enough to encompass most of the existing psychopathology; (b) the typology described is well defined and differentiated so that it is useful to discriminate various kinds of pathology; (c) the method of classifying is clinically oriented, meaningful, and practical, so that it can be easily applied for clinical diagnosis and be useful to guide therapeutic approaches. Several other points should be considered. The designed classification system should incorporate as much as possible the previously discovered and described family typologies. It also should take into consideration the clinical knowledge and theories we have had regarding family pathology, many of which focus on the pathology of the identified patient in the family. Finally, it should consider the common types and structure of families in our current society, the varieties of or alternate family structures, and the most frequently encountered family dysfunctions, so that the classification system can meet the practical need of description and identification of dysfunction to be addressed in treatment. Viewing the family as a group with a special matrix is the trend in most recent family research and also is strongly advocated by family therapists as a clinical conceptualization (Ehrenwald, 1963; Riskin and Faunce, 1970; Titchener and Emerson, 1958). Our

26

Wen-Shing Tseng and John F. McDermott, Jr.

proposed classification system is a multidimensional framework which attempts to deal with the complexity of the nature of family organization. This is also in concert with the proposed DSM-III, which utilizes the multiaxial system for classification. PROPOSED SYSTl':M

The proposed triaxial classification of family function and dysfunction is illustrated schematically in figure 1. The first axis represents the developmental aspects of the family and deals with its historical or longitudinal dimensions. The second axis focuses on the subsysFigure I

TRIAXIS OF FAMILY DIMENSIONS 2nd AXIS:

3rd AXIS

FAMILY SUBSYSTEMS

FAMILY - GROUP (CROSS - SECTION)

(CROSS - SECTION)

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I st AXIS FAMILY DEVELOPMENT ( LONGITUDINAL)

27

Triaxial Family Classification

terns in the family; it identifies the major location(s) of the interpersonal problems within the family. and is based on cross-sectional study of family functions. The third axis views the family as a group. matrix, or system, and attempts to categorize the family dysfunction through this visual dimension. FIRST AXIS: FAMILY DEVELOPMENTAL DYSFUNCTIONS

Developmental Dysfunction

The dysfunctions described in this axis are centered around the dimension of family development. Different kinds of dysfunction or crisis may be observed at different stages of development (see figure 2).

Figure 2

FIRST AXIS: FAMILY DEVELOPMENTAL DYSFUNCTIONS

NORMAL

DYSFUNCTION

- - - CONTRACTING

FAMILY WITH

ADOLESCENT CHILDREN

Ft..MILY WITH SMALL CHILDREN

Fr.~.·H

1 h1

:lItLD BIRTH

MARRIAGE

FAMILY

- - - MATURING FAMILY

- - CHILO-REARING FAMILY

- - - CHILDBEARING

_ _ _ PRIMARY FAMILY

28

Wen-Shing Tseng and John F. McDermott, Jr.

Primary Family Dysfunction This condition refers to the dysfunction of couple as husband and wife. It reflects a developmental disability in establishing a compatible partnership, the failure to establish marital commitment, a neurotically symptomatic marriage because of conflicting unconscious expectations, or the difficulty in disengaging from one's family of origin. This dysfunction, centering around the "primary" family, is usually observed in the early stages of a marriage, but it may remain or recur at any stage of family life. Example 1. Bob and Mary have been separated three times in their two-year marriage and still are not sure whether or not they can work out their problems. They dated for two years and seemed very compatible, but the relationship changed rapidly after marriage. Bob did not seem as thoughtful as he had been during their courtship. He rarely took her out to dinner, and forgot her birthday and their anniversary. Mary seemed rather immature and did not care about the house. She expected that he would do many of the chores around the house, but that to Bob was woman's work. Her complaints led to shouting matches, which ended by her running home to her mother. Bob resented her turning to her mother for comfort. They decided that a trial separation might help them iron out their differences, but when they were apart, they found they missed each other. So they reconciled only to have the same disagreements with subsequent separations over and over. Childbearing Family Dysfunction This dysfunction occurs with the arrival of children in the family. Problems caused by the inadequate preparation of the parents for the new child may be related to the difficulty in shifting between marital and parental roles, or to the neurotic expectations associated with the new child. It may take place at the time of the birth of the first baby, or it may be observed at any time when subsequent children are born. Example 2. For several years, marriage progressed very well for Joe, a young doctor, and Sue, a Ph.D. candidate, until the birth of their first child. Both looked forward to their new child's arrival unaware of the disruption it would cause to their accustomed lifestyle. Sue had to postpone her studies in order to care for the baby, which isolated her from many activities and experiences that she had previously shared with Joe. Joe found it difficult to study at home or to sleep after being on call because of the baby's "un-

TriaxiaL FamiLy Classification

29

scheduled" crying, and consequently spent more time at the hospital and medical library than at home; or so it seemed to Sue. Forced to stay at home during the day with the baby and often alone in the evening while Joe studied, Sue gradually came to resent both her husband and baby . Joe likewise felt isolated and ignored by Sue, and resented the change in their relationship caused by the baby. Child-Rearing Family Dysfunction This disorder is centered around the difficult y in accommodating and rearing young children. It may be a failure to provide a wholesome psychological environment for the expanding family or difficulty in organizing the family as a group. It also represents a problem in reorganization of a family with variously aged children. The inability to deal with the issue of separateness and togetherness or to solve a triangular conAict may also be a specific form of dysfunction. ExampLe 3 . David and Beth are parents of three children , ages 2, 4, and 6. Their famil y seemed to function well until just recently; now there are frequent quarrels between David and Beth which center around their eldest child, 6-year-old Tom, a bright but extremel y shy boy. David, a career military man, always wanted an aggressive and athletic boy, pushes his son to participate in sports, and will not tolerate an y sign of timidity in Tom. Beth, on the other hand, pampers and shields Tom from all the roughhousing and conAicts of being a "little man." Whenever David scolds Tom for even the smallest matter, Beth immediately comes to her son's defense, which results in an emotional battle between the parents and general disruption of the relationship between the three family members. Maturing Family Dysfunction When the children reach the young adult stage, the family problems are focused on the role differentiation and issues of separation. The parents may have difficulty in disengaging themselves from their adult children as well as problems in reestablishing their marital equilibrium. It has been observed that adolescents often produce regression to an adolescent stage in other family members. ExampLe 4. The Ashfords and their children have always had a warm relationship, but now Paul , 18, and Eve, 16, are at the age where they want to make their own decisions and determine their

30

Wen -Shing Tseng and John F. McDermott, Jr.

own acn viues. Paul has de cided, against his father's wishes that he become an engineer, to stud y music in college. His parents continually try to persuade him, but he refuses even to discuss the issu e and threatens to move out of the house if they persist. On several occasions, Eve has stayed out past the curfew designated by her parents and, when questioned by her mother, says that her parents are "too square" and no longer have the right to dictate her actions. The old warmth and understanding in the family have become almost a hol y war between two armed fronts , neither of which will discuss the differences with the other. Eve knew exactly the fringe groups to join which would provoke her conservative parents who were trying to hold on to her as a younger person. Contracting Family Dysfunction The difficulties encountered by the agmg family are the lack of preparation for, or the inability to accept, the loss of a member, and the failure to readjust to a family life pattern and cope with the loneliness and insecurity at this stage of family life. Example 5. The Smiths have had a comfortable and happy family life for nearly 30 years. However, the coincidence of the youngest daughter's unexpected marriage and Mr. Smith's retirement threw the family into an unusual state of discord. Mr. Smith tries to busy himself with dail y work in the garden and sports , but a touch of arthritis shortly terminates these activities. Without any responsibilities of his own to occupy his attention, Mr. Smith is constantly "underfoot," while his wife attempts to care for her home as she has for 30 years. But his new questioning and criticism of her activities frustrate and upset Mrs. Smith, who now frequently calls her daughter for comfort and sympath y. Both parents feel lonely and isolated from their ch ild ren's lives; although they still have ea ch other, their lives seem to have lost some of their former meaning and significance. Developmental Complications and Variations

This category includes any family disturbance which may be conce ptualized as the complications or variations of "usual" family development. Interrupted Family This co nd itio n refers to a famil y crisis associated with separation or divorce (of the parents). Difficulty in coping with separation and at-

Triaxial Family Classification

31

tachment, the problems of handling the unresolved negative feelings associated with divorce, and failure in negotiating the custody of the children are the main issues involved in this family dysfunction. Example 6. After their divorce the Wilsons engaged for five years in a war over their children, Betsy, 14, and Charles, 12. Each parent polarized and fought for control and power symbolized by the youngster's loyalty. Each knew the other's vulnerability and exploited it. Mr. Wilson, knowing- his former wife's need to control and know things were in order, would make his visitation trips with the children vague and unclear, although in other ways he was a highly organized person. Mrs. Wilson made the children promise not to tell their father when they were in school plays and events, so "the three of them could go as a family." Betsy was becoming withdrawn and severely depressed, while Charles was highly anxious and scapegoated at school because of his attachment to his family. One-Parent Family A family may manifest problems due to the presence of only one parent in the family after the divorce. The difficulties usually center around the support, care, and discipline of children as well as on their cross-sexual identification. Example 7. Sarah seemed completely helpless to manage her increasingly unsocialized children after her husband divorced her. While competent at her job, she related as one of the children at home, so much so that her 12-year-old daughter began to assume a maternal role toward her and the younger children, whose resentment became even greater. Reconstructed Family Dysfunction For the stepfamily, establishment of new role divisions between parents, parents and children, and between children and children

is the main problem to be addressed, and obstacles may reflect previous issues and identities in the bilateral family histories. Example 8. Bill, a divorcee with three children, married Kathy with the hope that the marriage would be good for him and his family. But Bill's children, influenced by their own mother, are not receptive to Kathy's affection and openly resent her discipline. Kathy's own child is treated quite miserably by her new stepbrother and sister, but runs away from home rather than cause problems for her mom and her new stepfather.

32

Wen-Shing Tseng and John F. McDermott, Jr.

Chronically Unstable Family This category refers to the family characterized by frequent moves, separations, or divorces. The prevailing conditions are lack of consistency and stability in the lives of family members individually and together. Confusion in role division and family boundaries may also occur. SECOND AXIS: FAMILY SUBSYSTEM DYSFUNCTION

In this axis of classification, attention is focused on problems in the subsystems of the family. This "focusing down" on family pathology identifies the principal members within the family to whom the dysfunction can be traced.

Spouse-Subsystem Dysfunction The major site of dysfunction originates in the marriage. The two adults may function quite well as separate individuals, but their interactions as a couple are dominated by conflicting unconscious neurotic needs which may spread and involve the whole family. Due to the nature of the spouses' relationship, their marital problems are subcategorized in the following groups (see figure 3). Complementary Marital Dysfunction The marital relationship is characterized by the combination of two people with pathologically complementary types of behavior and character. Such a relationship is unbalanced because of the very dissimilar personalities, but nevertheless is often stable because it is need fulfilling. Basically it is fragile and labile, easily destabilized, and pathological in nature. Such complementary combinations can be further subcategorized: (a) dominant vs. submissive; (b) emotionally detached, cold vs. affection craving, emotional; (c) obsessive-compulsive vs. hysterical; (d) omnipotent, endlessly supportive vs. dependent, helpless; (e) sadistic vs. masochistic. Conflicting Marital Dysfunction The marital relationship is characterized by the combination of two people who have the same tendency to seek control and power. The problems stemming from such similarities result in constant competitive, rivalrous, and conflictual relations. In spite of the long-standing situation of tension and confrontation, the marital relationship between the couple continues to thrive.

33

Triaxial Family Classification

Figure 3

SECOND AXIS: FAMILY SUBSYSTEM DYSFUNCTION ( NORMAL SPOUSE SUBSYSTEM)

SPOUSE - SUBSYSTEM DYSFUNCTION

COMPLEMENTARY MARITAL DYSFUNCTION

CONFLICTING MARITAL OVSFUNCTION

DEPENDENT MARITAL DYSFUNCTION

DISENGAGED MARITAL DYSFUNCTION

(aB) _---, .....

INCOMPATIBLE MARITAL DYSFUNCTION

(:oB~~ ---_ ......

Dependent Marital Dysfunction

The marriage is composed of two people who are mutually dependent, helpless, or emotionally immature. Such a relationship has an inbred vulnerability because any separation of the couple may result in the inability of one or both to function as individuals. Disengaged Marital Dysfunction This marriage is characterized by the decreased interaction and emotional involvement between the partners. However, for social,

34

Wen-Shing Tseng and John F. McDermott, Jr.

cultural, or religious reasons, it is easier to maintain the marriage. Or they may continue a numb and apathetic relationship, completely void of any vitality, because of their extremely passive personalities which seek no change or alteration of their accustomed routine. Incompatible Marital Dysfunction This relationship is marked by the existence of wide differences in personalities, value systems, styles of living; frequently, there are vast differences in age, education, and occupation which result in an incompatibility in the couple's roles of husband and wife and continual chaos and attempts at readjustment.

Parent-Child Subsystem Dysfunction The problems are concentrated in the parent-child interaction system. Based on the emphasis of focus, either on the parent, the child, or the parent-child, the dysfunction is subdivided into the following categories (see figure 4): Parent-Related Dysfunction This type of pathology is dominated by a parent's characterological or neurotic condition interfering with the parenting ability. The parent's pathological expectations for the child, projective identifications, and distorted reactions to a child as representing someone else; age-inappropriate child-rearing techniques; inadequate parenting behavior; or extreme parental favoritism and rejection are all examples of such parent-reaction problems. Child-Related Dysfunction Here the family dysfunction is primarily caused by the pathology of a child. The child has a well-delineated organic, maturational, developmental, neurotic, or psychotic disturbance which disrupts the functioning of the family. The family dysfunction can be viewed as a direct reaction to such a child's problems. Parent-Child Interrelational Dysfunction The highlight of this family dysfunction is the disturbance in the parent-child interaction. Commonly recognized examples are: overinvestment of a parent in a child, echoed by excessive attachment of the child to the parent, resulting in so-called "symbiotic" relations; the excessively controlling parent paired with an overly inhibited child; or mutually hostile rejecting parent-child interrelations.

Triaxial Family Classification

35

Figure 4

PARENT-CHILD SUBSYSTEM DYSFUNCTION PARENT - RELATED DYSFUNCTION

CHILD -RELATED DYSFUNCTION

PARENT - CHILD INTERRELATIONAL DISFUNCTION

PARENT-CHILD TRIANGULAR DYSFUNCTION

SIBLING SUBSYSTEM DYSFUNCTION

Parents-Child Triangular Dysfunction This family disturbance is centered around the obvious pathology of two parents and the intensive involvement of a particular child, resulting in a triadic conflict. Usually both parents have some underlying unresolved problems related to their own development; these remain latent until one of the children approaches a particular stage of development when these salient issues are brought into open conflict.

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Wen -Shing Tseng and John F. McDermott, Jr.

Sibling Subsystem Dysfunction

The disturbance is observed primarily between or among siblings, even though such problems may extend to and involve other family members . The sibling interactional pathology may be manifested as excessive destructive rivalry , overidentification and undifferentiation between siblings, or as coalitions against parent(s). THIRD AXIS: FAMILY GROUP DYSFUNCTION

In this axis of classification, the family is conceptualized as a "gro u p" forming a single "system," and the dysfunctions of the family are viewed through such a group-system orientation. Structural-Functional Dysfunctions

The family groups are examined from various aspects of structure-function such as organization, integration, group boundaries, role division, communication, emotional atmosphere, or task performance. Based on these aspects the family dysfunctions are categorized as follows (see figure 5): Underperforming Family The family is headed by parents who have immature personalities. They lack the ability to lead the family. Consequently , the family as a group is poorly organized, has difficulty in communicating well or in making decisions effectively; as a family group they tend to perform inadequately. Example 9. Nancy, an obese girl of 8, was initially referred for professional help because of her weight problem, poor academic record , and limited participation in school activities. During the family interview, Nancy's parents were unable to describe the daily activities in their home. It was unclear who was responsible for what in the Thomas household; Mr. Thomas said that he occasionally cooked and cleaned, but he thought that Nancy also had some chores in the house. The father, an extremely passive man, barely spoke during the interview; his wife, overweight and rather immature, giggled with her daughter at the interviewer's questions. Mr. Thomas did not know what subjects Nancy was taking in school or if she had homework. Mrs. Thomas replied that she, like Nancy, never liked school. The relationship between mother and daughter seemed more that of sisters as they sat exchanging mints during the session. The parents' behavior and their inability to discuss solutions with the interviewer were suggestive of a family operating at a very minimal level.

37

Triaxial Family Classification

Figure 5

THIRD AXIS: FAMILY GROUP DYSFUNCTION STRUCTURAL - FUNCTIONAL DYSFUNCTION NORMAL FAMILYGROUP

UNDERPERFORMING FAMILY

OVERSTRUCTURED FAMILY

PATHOLOGICALLY INTEGRATED FAMILY

•• m~~

W W t82I

EMOTIONALLY DETACHED FAMILY

DISORGANIZED FAMILY

Overstructured Family The family is headed by a perfectionistic parent who influences the whole family to become highly task-oriented and principally concerned with discipline and achievement. The family as a group tends to function primarily with structure and by orders, but often lacks emotional interaction and warmth. Example 10. The Ryan household functions by extreme efficiency and strict discipline. Mr. Ryan, a chemist, and his wife, a computer analyst, require that every family function be completed according to schedule. The young Ryans, ages II, 13, and 15, go to bed at

38

Wen-Shing Tseng andJohn F. McDermott, Jr.

their individually appointed times and rise at the simultaneous ringing of the family alarm clocks, even on weekends. Conversation at mealtime is designated for family matters, where even Mrs. Ryan must be recognized by Mr. Ryan in order to speak. The tenor of the family is absolute regimentation. Pathologically Integrated Family The family is characterized by an inappropriately assigned, but pathologically balanced, role division among family members. Even though the general picture of the family-intermember relationship appears extremely misdirected or unbalanced, the family as a group is still able to function at a superficial level without taskperformance im pairment. Example 11. The Rices seem like an average family, but a community survey taker found the operation of the household quite unusual. For the last five years, Mrs. Rice has been the principal breadwinner, while her husband does all the family cooking and cleaning. Donna, 17, is both her father's sympathetic sounding board as well as her mother's adviser on financial matters. Any family disagreement or major decision is resolved not by Mr. Rice but by Marshall, his elder son. Emotionally Detached Family Basically the family members are dissatisfied with each other; there may exist an underlying anger or hostility among them. All parties are emotionally disengaged and have difficulty being involved as a whole group. However, for external reasons, financial necessity, religious or social expectations, they maintain a minimal association as a family, while each individual has a separate or private existence. Example 12. The atmosphere in the Young home is polite but loveless. Myra Young married Paul to escape the violence of World War II Europe; Paul fantasized that he rescued a lovely girl. Shortly after the wedding, Myra became disillusioned with the marriage but feared having to return to Austria. Paul, a Catholic, would not agree to a divorce. Their IS-year-old son, Paul Jr., survives by keeping busy with his friends and avoids his sterile, cold home as much as possible. In a family interview session, each individual was receptive to the interviewer, yet was distant and uncomfortable with the other family members; they even avoided eye contact. There was no sense of a family unit or cohesiveness at all.

Triaxial Family Classification

39

Disorganized Family The family has multiple problems in group functions, which include role division, communication, and organization. Role differentiation is unclear or confused, communication is ambiguous or ineffective, and the organization is chaotic. Thus the family as a whole is characterized by its disintegration and disorganization. Example 13. In class, Ray is an extremely uncooperative student; he always seems distracted and. inattentive when everyone else is at work. When corrected by his teacher, he either totally ignores her or has temper tantrums, disrupting the entire class. During a family conference called by the school counselor, the atmosphere reached a level of sheer chaos. Ray's father repeatedly asked his son about his disruptive behavior but received no response. Ray's mother made a comment which did not relate to the problem of immediate concern, while Ray, ignoring both parents, began a conversation with his older sister. Suddenly the family became silent and then abruptly continued its unconnected conversations. Social Coping Dysfunction

In this category, the family dysfunction is viewed as the manifestation of a family's coping style in relationship to other families. The various coping patterns may be regarded as attitudes of living or as the central theme of concern for the entire family. Thus, the dysfunction is family-culture related rather than structure-related (see figure 6). Socially Isolated Family The family is characterized by excessive isolation from the community and little or no contact with members of the extended families. As a family, they are superficially integrated internally, but they prefer the life-style of not integrating with the community as a way of coping with their internal insecurity. Socially Deviant Family This unit is characterized by revolt against community mores, nonconformity with social standards, and deviant goals of family life. Special-Theme Family The family life is dominated by commonly shared themes, myths, secrets, or cultural beliefs. The family theme is usually developed by both parents and shared by the total family; it is unique to an

Wen-Shing Tseng and John F. McDermott, Jr.

40

Figure 6 SOCIAL COPING DYSFUNCTIONS

SOCIALLY DEVIANT FAMILY

EXTERNALLY (SOCIALLY) ISOLATED FAMILY

000 0 0 0,00 OOf\ 1\ 1\ : :@j' :! //0 , / \ / ~

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SPECIAL- THEME FAMILY

individual family but not necessarily to any other family. A particular member of the family, usually a child, may be selected both by himself and other family members to be the "carrier" of the theme in the family. Example 14, Herbert and Alice Cameron are determined that their children will get a first-class education and have a better life than they had, so every activity of the family is directed toward that shared goal. Mr. Cameron zealously works two jobs to save for his children's future college expenses. Mrs. Cameron, self-conscious of her laborer-class background, struggles to better the family's social

Triaxial Family Classification

41

standing by doing charity and CIVIC functions with the City Women's Guild . Michael, age 12 and an A + student, has been referred to the child psychiatry clinic by his teacher because he never socializes with his classmates and seems very tense most of the time. The same behavior was observed in his sister, Lisa, who burst into tears in class when she did not receive the highest grade on a math test. The children's behavior reflects their preoccupation with their parents' plans and concerns for position. DISCUSSION

The family classification system proposed in this report is a multiaxial one. The three axes described in this system are used simultaneously, i.e. ,family development, the family subsystems, and the family as a group system. The diagnostic formulation may suggest that a family has a dysfunction in one dimension, while in the others it is functioning within normal limits or is less disturbed . Most importantly, the formulation points to priorities for intervention, even when more than one disturbance is apparent during classification. The main thrust of this system of classification is to help the clinician grasp the nature of the pathology from a multidimensional point of view as well as to assist him in developing appropriate therapeutic measures for the family concerned: to focus on a particular individual member of the family, subsystem of the family, or the family as a group. In addition, it provides reliability when a number of clinicians are independently assessing family functioning and psychopathology. This makes it potentially useful in training clinicians and in research projects involving the family unit. Of course, we must realize that there are alternative family systems in our society today. For example, a shift with the rising divorce rate toward single-parent families, or even the single-parent family as the beginning nuclear family, requires us to modify each dimension, redrawing the longitudinal axis of family development to fit this differing model, as well as its subsystems and the system itself. The model presented may appear traditional and "middle class." This does not reflect a value, but is intended only to be a starting point. Finally, the family can be considered a dynamic organization which is constantly growing and changing. Therefore , the diagnosis of family pathology should not reflect the use of a fixed "label," and any diagnosis given at one time may be changed or reevaluated on an ongoing basis. While the "co nce ptualized skele-

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Wen-Shing Tseng andJohn F. McDermott, Jr.

ton" of this proposed system seems to us to be a useful approach, the instrument itself, i.e., the details of the categorization and description of the particular dysfunctions, will need considerable improvement and/or revision. Subsequent clinical trials may point to strengths and weaknesses as well as suggest im provements in the system proposed here.

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Triaxial Family Classification

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