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Epstein1978 PDF
Epstein1978 PDF
of Family Functioning
Nathan B. Epstein*
Duane S. Bishop**
Sol Levin***
The model of family functioning being presented is the product of over twenty
years of research in clinical work with family units. A method of family
therapy has been developed based upon this model and will be described in a
future issue. The model utilizes a general systems theory approach in an
attempt to describe the structure, organization, and transactional patterns of
the family unit. It allows examination of families along the total spectrum
ranging fiom healthy to severely pathological in their functioning. It is based
upon a Judaeo-Christianvalue set, and allows attention to be paid to cultural
differencesand other issues of cultural relativity.
Family therapy has become a n increasingly popular mode of treatment over the
last two decades (Epstein & Bishop, 1973; G.A.P., 1970; Gurman & Kniskern, in press;
Haley, 1971; Olson, 1970; Zuk, 1971).Its acceptance has not been limited to psychiatry
and other mental health fields, for it is increasingly viewed as an important develop-
ment by Family Medicine (Comley, 1973; Epstein & McAuley, 1978; McFarlane, et al.,
1971a, 1971b; Patriarche, 1974; Stanford, 1972) and by Pediatrics (Finkel, 1974;
McClelland, et al., 1973; Tomm, 1973). Training programs and study curricula in
family therapy have grown tremendously in the last ten years, and reports of a signifi-
cant amount of research have also appeared (Glick & Haley, 1971; Gurman & Knis-
kern, in press; Olson, 1970).
Despite this explosive growth and popularity, the diagnosis of a family who seeks
mental and/or general health services is still basically restricted to clinical judgment,
and this demands a conceptual model of family functioning. Literature reviews expose
the general diversity of conceptual models of family functioning, indicating the lack of
a generally accepted conceptual framework within which to perform a family assess-
ment. With many schools and models represented in the literature, the onus for
detailing the models and their development lies with the proponents of each approach.
This presentation details the further development of one approach-The McMaster
Model of Family Functioning.
*Nathan B. Epstein, MD, FRCP (C) is Professor and Chairman, Section of Psychiatry and
Human Behavior, Brown University-Butler Hospital, 345 Blackstone Blvd., Providence, Rhode
Island 02906. (Requests for reprints should be sent to him.)
**Duane S. Bishop, MD, FRCP (C) is Assistant Professor, Department of Psychiatry at
McMaster University, Hamilton, Ontario.
***Sol Levin, MD, FRCP (C) is Professor and Chairman, Department of Psychiatry, North-
eastern Ohio Universities College of Medicine, Akron, Ohio.
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basis of thinking for the current model (Westley & Epstein, 1969).Significant develop-
ment and revision of the original concepts have taken place, such that the approach
requires a new statement.
An important aspect of this conceptual model is its clinical utility. It has been
developed and used extensively in a variety of psychiatric and family practice clinics
(Comley, 1973;Epstein & Westley, 1959;Guttman, et al., 1971,1972;Postner, et al.,
1971;Rakoff, 1967;Sigal, et al., 1967;Westley & Epstein, 1960)and by therapists who
treated families as part of a large Family Therapy Outcome Study (Guttman, 1971;
Santa-Barbara, et al., 1975;Woodward, et al., 1974,1975,1977).The framework has
also been used in a Family Therapy Training Program’ and found to be readily
teachable. We make no claim that this is “the” model of family functioning. While not
addressed to all aspects of family functioning, the model does focus on certain aspects
which we have found important in dealing with clinically presenting families. The
model deals with the full spectrum of family functioning from health to pathology and,
therefore, should allow the placement of a given family’s functioning on this spectrum.
Values have a great effect on the judgment and evaluation of behaviour, and they
have to be taken into consideration using this model. The great deal of cultural
variation that occurs &ects the behaviour of people living in groups, and has to be
understood and handled with care by practicing clinicians. When dealing with families
we operate on Western Judaeo-Christian values which emphasize the optimal develop-
ment of each human being. Any number of other systems may provide a value base,
and might be equally valid. We do not try to impose our own values, but believe that
those behavioural scientists working in the field should be prepared to state the value
base on which their approach rests (Epstein, 1958).
The model of family functioning is based on a systems approach as described by
Epstein and Bishop (1973,p. 176):
In this approach the family is seen as an ‘open system’ consisting of systems within
system (individual, marital dyad) and relating to other systems (extended family,
schools, industry, religions).The unique aspect of the dynamic family group cannot be
simply reduced to the characteristicsof the individualsor interactions between pairs of
members. Rather, there are explicit and implicit rules, plus action by members, which
govern and monitor each other’sbehaviour. The significancefor therapy is the fact that
the therapist is not concerned with what it is in the family which produced pathology
in the individual, but rather with the processes occurring within the family system
which produce the behaviour which is labeled pathology. Therapy on this basis is
direded at changing the system and, thereby, the individual.The concepts of commu-
nication theory, learning theory, and transaction approach are drawn on, although the
infra-structureremains the systems model.
Or, in Spiegel’s words (1971,p. 381,“the ancient and honourable problems of the
relation of one to the many can be solved only by finding a pattern in which the many
appear as parts of the one”. Spiegel outlined the differences between self-action (intra-
psychic process), interaction, and transaction. Olson (1970,p. 509)has also elaborated
on this and cites Dewey and Bentley’s (1949)definition of the differences between
interaction and transaction. A recent article by Ritterman (1977)also addresses the
differentiation.
The aspects of systems theory which underlie the model to be presented can be
summarized as follows:
1. Parts of the family are related to each other.
2. One part of the family cannot be understood in isolation from the rest of the
system.
3. Family functioning is more than just the sum of the parts.
Family Dimensions
The McMaster Model considers family functioning in the following dimensions:
Problem Solving, Communication, Roles, Affective Responsiveness, Mective Involve-
ment, and Behaviour Control.
Some groups studying family functioning conceptualize much of family behaviour
as occurring within a single dimension such as communication (Bateson, et al., 1956;
Watzlawick, et al., 1967;Weakland, et al., 1974;Westley & Epstein, 1969)or role
behaviours (Parsons, 1951;Parsons & Bales, 1955;Spiegel, 1971). In contrast, the
McMaster Model does not focus on any one dimension as the foundation for concep-
tualizing family behaviour. We feel many dimensions need to be assessed for fuller
understanding of such a complex entity as the family. Although we attempt to clearly
define and delineate the dimensions, we recognize the potential overlap and/or possible
interaction that may occur between them. Further clarification will undoubtedly result
from our continuing research.
Each dimension will now be defined, and a summary of the concepts is outlined in
Appendix “A”.
Problem Solving
The problem solving dimension is defined as: a family’s ability to resolve problems
to a level that maintains effective family functioning. A family problem is seen as: an
Communication
We define communication as: how the family exchanges information. The focua is
solely on verbal exchange. We are fully aware that this definition is constricted. Non-
verbal asp- of family communication are tremendously important but are excluded
here because of the methodological difficulties of collecting and measuring such data
for research purposes at this point in time.
Communication is also subdivided into instrumental and affective areas. Although
there can be overlap between the two areas, clinical experience has shown that some
families can have marked difficulties with affective communication while functioning
very well in the area of instrumental communication, but the reverse is rarely, if ever,
seen.
In addition, communication is assessed along two other vectors. These are the clear
us. masked continuum and the direct us. indirect continuum. The former focuses on the
clarity with which the content of the information is exchanged. Is the message clear, or
is it camouflaged, muddied, vague, and masked? “he latter considers whether the
message goes to the person for whom it is intended.
It is possible on the basis of the two continua to arrive a t four styles of communica-
tion. The first style would be clear and direct communication. An example of this for
the effective communication of anger about Joe, an accountant, would be, “Joe, I’m
angry at you because . . .” The second style is clear and indirect communication. Here
the message is clear, but who it is intended for is not. Following on the previous
example, the communication would be, “Accountants sure make me angry when. . .”, a
message that might or might not be intended for Joe. The third style is masked and
direct communication. Here the content would be unclear but would be directed to the
person for whom it is intended. Our example would be, “Joe, you look terrible today!”
The fourth style is masked and indirect communication. Here the content of the
message and who it is intended for are both unclear. Our example now becomes, “You
know, accountants give me a pain!”
It is postulated that the more masked and indirect the overall family communica-
tion pattern, the more ineffective the family’s functioning will be, while the more clear
and direct the communication, the more effective it will be. It is further postulated that
masked and/or indirect communication invites a similar response from the recipient of
the message.
The understanding of communication as we define it does not exclude, and indeed
the clinical situation may a t times require, consideration of such other variables as
content, the potential for multiple messages, and checking whether the communication
sent is appropriately attended to and interpreted by the receiver. These considera-
tions are consonant with the principles of communication outlined by Lederer and
Jackson (1968).
Roles
The definition given to family roles is: Family roles are the repetitive patterns of
behaviour by which individuals fulfill family functions. The present model also divides
family functions into instrumental and affective areas, with all of the implications
previously mentioned. In addition, the functions are broken down into two further
spheres-necessary family functions and other family functions. Necessary family func-
I Instrumental
Necessary Family Functions
Affective
: Provision of Resources : Nurturance and Support
: Sexual Gratification of
Marital Partners
: Life Skills Development
: Systems Management and Maintenance
L
Figure 1
Affective Responsiveness
Affective responsiveness is defined as: the ability to respond to a range of stimuli
with appropriate quality and quantity of feelings. The focus is on the pattern of the
family’s responses to affective stimuli. (How they let each other know about those
feelings is not considered in this dimension but within that of affective communication.)
The responses are divided into two classes-welfare feelings and emergency feelings
(cf. Rado, 1961).Welfare emotions are exemplified by responses such as love, tender-
ness, happiness, and joy, and emergency emotions by fear, anger, sadness, disappoint-
ment, and depression. The appropriateness, quality, and quantity of the responses of
the family and its various members to affective stimuli are considered. A family which
can respond appropriately with love and tenderness but never with feelings of anger,
sadness, or joy would be considered restricted and somewhat distorted. Further, it is
postulated that the children in such a family would develop affective constriction
which might strongly influence their personal development. The more effective the
family, the wider the range and the more appropriate will be their responses in terms
of quantity and quality for the given situation.
We are aware that factors related to cultural variability may have a marked and
important influence on the affective responsiveness of families. Though time and space
do not allow us to elaborate on this a t this point, consideration obviously must be given
to the issue of cultural differences within the confines of our definition.
Affective Involvement
The dimension of affective involvement is defined as: the degree to which the
family shows interest in and values the activities and interests of family members. The
focus is on how much and in what way family members can show an interest and invest
themselves in each other. There is a range of possible involvement along a spectrum as
follows:
1. Lack of involvement
2. Involvement devoid of feelings
3. Narcissistic involvement
4. Empathic involvement
5. Over-involvement
6. Symbiotic involvement
At one end of the spectrum is lack of involvement designating those situations
where family members show no interest or investment in each other. Their only
Behaviour Control
The behaviour control dimension is defined as: The pattern the family adopts for
handling behaviour in three specific situations-physically dangerous situations, sit-
uations involving the meeting and expressing of psychobiologicalneeds and drives, and
situations involving socializing behaviour both inside and outside the family. There
are a number of obviously physically dangerous situations where the family will have
to monitor and control the behaviour of its members. Family members obviously
attempt to meet and express a number of psychobiological needs and drives, including
eating, sleeping, eliminating, sex, and aggression, and the family will adopt patterns
for the control of such behaviours. Families also develop methods of controlling inter-
personal socializing behaviour between the family members as well as that involving
people outside of the family. The inside/outside distinction is made because the pattern
of acceptable behaviour in each area may differ.
This definition embodies more than a consideration of child discipline. There are
dangerous situations such as running into the road, playing in dangerous surroundings
or with matches, that apply to children. An equal number of examples exist for adults
and might include behaviour such as suicide attempts and reckless driving. It is impor-
tant, then, to consider all family members' behaviours in each of these situations when
conceptualizing the dimension of behaviour control.
For each of these previously mentioned three areas families develop a standard of
acceptable behaviour and of how much latitude they will allow in relationship to the
standard. The standard and latitude for acceptable behaviour determines the style of
behaviour control. The four styles of behaviour control are classified as follows:
1. Rigid behaviour control
2. Flexible behaviour control
3. Laissez-faire behaviour control
4. Chaotic behaviour control
Conclusion
There is no generally accepted model of family functioning which allows assess-
ment to be performed in the course of family therapy practice. This article reviews the
McMaster Model of Family Functioning now being used successfully in a number of
clinical settings and teaching programs. Recent elaboration and clarification of the
model justifies its publication. A more detailed discussion of the literature will follow
in a monograph planned for the future. Our current research and work towards the
development of a family assessment device based on the Model will add to the under-
standing and knowledge of the Model and allow testing of the validity of the hypotheses
presented in this article.
The increasing demands for accountability from psychotherapists regarding their
psychotherapy require clear statements of models and approaches. In our experience
this model is clinically useful, teachable, and provides a framework which family
therapists can consistently use to conceptualize their work with families.
Appendix “A”
Summary of Dimension Concepts
Postulated
: Most e f f e c t i v d l e a r and direct
: Least effectiv-Masked and indirect
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FOOTNOTES
‘The Family Studies portion of the Clinical Behavioural Sciences Program, McMaster Univer-
sity, Faculty of Health Sciences, Hamilton, Ontario.
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