Generational bonds. Clinical assessment instruments
The present book aims at providing clinicians with a set of “expressive” instruments to evaluate and assess family bonds; specifically three instruments are presented: the Clinical Generational Interview (CGI), the Family Life Space (FLS), and the Conjoint Family Drawing (CFD). These instruments have been selected because they have both assessment and therapeutic purposes, in other words they can be conceived as media facilitating and fostering the therapeutic relationship while helping the clinician gain a privileged look into the family dynamics and relationships. Allowing the clinician and his/her clients to share meaningful moments and places (both emotional and physical), such instruments facilitate the building of a solid therapeutic alliance while also enabling the researcher/clinician to truly understand family relations by sharing their rituals, witnessing to their exchanges, and becoming aware of their critical transitions.
The book starts by briefly introducing the Relational Symbolic Model, the model provides the framework and at the same time lays at the basis of the three instruments that are presented in the following chapters. Specifically, the three principles laying at the basis of the Model are described along with its key constructs. Developed by Cigoli and Scabini in the ‘80s, the Relational Symbolic Model is based upon three principles: the organizational, symbolic, and dynamic one. According to the organizational principle, the family is an organized system with specific roles, tasks, routines, and hierarchies. Specifically, the family organizes primary relationships based on three types of difference: the difference between genders, the difference between generations and that between family lineages. The outcome of the combination of such differences is generativity (or its contrary, degenerativity), which is the final aim of every family form. By generativity we do not merely mean the desire to procreate but, more broadly, the willingness and commitment towards generating something new, being creative and devoting oneself to a project or goal. The symbolic principle refers to the underlying structure that connects the basic aspects of family relations. Etymologically, the word “symbol” refers to that what binds or ties together and, by means of uniting or connecting different parts, allows recognition. In our model, the symbolic principle is the expression of what we consider “family-ness”, which, in turn, is declined into an affective and an ethic pole. The affective aspect of family relations entails qualities such as faith and hope whereas the ethical pole has to do with qualities such as justice and loyalty. The family merges and combines together both these poles: family relations are, in fact, characterized by both affection and love as well as responsibilities and commitments. These symbolic dimensions are always operating and defining family relations but they become particularly evident during family transitions, that is, during critical moments (i.e., the death of a loved one, a marriage, an unexpected accident or a migration) of the family life-cycle in which family relations need to be restructured or reorganized. The third principle (i.e., the dynamic one) has to do with the three basic actions at the basis of family relationships: giving, receiving, and reciprocating. Contrarily to both the “exchange theory” which adopts an utilitarian, and ultimately oversimplistic perspective and the multigenerational approach adopted by Nagy and Spark (1988), which, although intriguing, takes up a rather deterministic perspective that does not account for the unexpected, our model draws upon the concept of gift as intended by ethno-anthropologists (Godbout, 1992). In such a perspective, the gift is intended as the expression of trust: something is given for free and unconditionally and such gesture lays at the basis of any relations, both personal and social.
The constructs that are at the basis of this model are: generativity (conceived as the ultimate goal of each family), family ties, intergenerational bonds, trust, hope, justice, and transitions. In order to empirically observe such constructs, we developed a set of expressive-constructive instruments. Unlike self-report instruments, that are media between the researcher and the subjects, expressive-constructive instruments are at the very origin of the relationship between the researcher and the subjects, therefore the final product (the test outcome) is the result of a conjoint effort between the researcher and the participants and this allows to both assess and treat family ties. More specifically, such instruments have proven to be extremely useful both for the research on family relations as well as in the clinical practice. Allowing the formation of a relationship between the family and the researcher, these instruments facilitate the creation of a “working group”, which is fundamental for the positive outcome of the whole process. In such a perspective, the researcher/clinician aims at working, together with the family or the parental couple, in favor of the “relational vineyard”, that is that intricate twist of branches (bonds) that run up and down the “family tree” and that can either be helped to thrive or, rather, let dry. The use of expressive-constructive instruments offers several advantages: first, they involve the family as a whole: in other words, they consider the family as unity, as something that is more than the mere sum of its parts. Secondly, such instruments allow to explore the family interactive dimension. The observation of the interaction in the “here and now” helps researchers detect recurrent interactional patterns while providing them with an understanding of the family functioning and ways to cope with unforeseen tasks. Additionally, capitalizing on a graphical-symbolic dimension, such instruments are less affected by linguistic biases and social desirability than questionnaires or interviews. Moreover, all these instruments provide two types of information: information on the process (how the family members interact while performing the task), and information on the outcome (what is the final product, who and in what way gave its contribution and what are its features).
More specifically, the book presents three clinical assessment instruments: the Conjoint Family Drawing (CFD), the Family Life Space (FLS), and the Clinical Generational Interview (CGI). Following a brief explanation of each instrument and of their respective coding grid, some clinical vignettes are also presented.
The Conjoint Family Drawing (CFD) is one of the most innovative techniques that makes use of drawings to assess family relations. Originally developed by Elizabeth Bing (1970) to be used in clinical settings, the CFD draws on art therapy and collaborative techniques used in family therapy. As for the Family Life Space (which will be presented later), the whole family is involved in the test administration. More specifically, the family is given a 70X90cm white sheet and different color markers. Each family member is asked to choose a marker that he/she will be using throughout the whole session. The sheet is either hung on a wall or laid on a flat surface (a table or the floor in case younger children take part to the drawing session too). At the beginning of the administration, the researcher/clinician provides the following instructions: “I would like you all to use this sheet to draw a picture of your family doing something. You can now take some time to decide together what to draw”. Instructions are purposely generic and ambiguous and invite family members to take a shared decision on the scene to be drawn. The final product is examined by the researcher/clinician on the basis of two types of indicators: process and outcome indicators. With regards to the process of making the drawing, some important indicators to be kept into account are: the family ability/inability to follow the instructions, the sequence and way in which the drawing unfolds (e.g. who decides what to draw, who starts drawing, how is the family organizing the turns), the family interactions and exchanges during the drawing and each family member’s reactions to the drawing made by the others (e.g., one member completes/embellishes the drawing of another or one member erases/destroys the drawing of another). With regards to the final outcome, importance is given to the use of space (i.e., the amount of space occupied by the drawing, the area of the sheet where each member places his/her drawing, the occupation of the center), the overall emotional impression inspired by the drawing (is the scene represented happy or sad?) and its content (were the family members capable of deciding on a single scene to be represented? Are there different scenes depicted in the drawing? If yes, who was involved in the drawing of each scene? Are all the family members represented in the picture? Are they represented in a realistic or unrealistic way?).
The Family Life Space (FLS) is a graphic symbolic instrument originally developed by Danuta Mostwin in the late 70’s to be used in clinical settings. Its theoretical and conceptual framework draws on the general systems theory and symbolic interactionism. In particular, the FLS defines the family space as a bio-psycho-social territory dense with meaning (Barker & Barker,1990; Mostwin, 1976; 1980). The instrument is based on the assumption that the structures and dynamics that feature a family can be best represented by asking members to interact while drawing graphic symbols on a piece of paper. The family “action” takes place and shape before the researcher and the Family Life Space “offers” the space and time to capture the organization and the way of living of that family (Gozzoli & Tamanza, 1998).
A white sheet (50x70cm) with a circle drawn in the center is presented before the family and members are each given a marker. Participants are told that the circle represents the life space of their family and are subsequently invited to place themselves with respect to the circle (they can choose to draw inside, outside the circle or on the border). After having placed themselves, participants are asked to place their loved ones, either dead or alive, as well as the important events, things, and organizations in their lives. Finally, participants are asked to draw lines between the various elements in their drawing symbolizing the type of relation they have with those elements: a straight line symbolizes a positive relationship, a dotted line represents a substantially positive relationships but with occasional strong arguments or disagreements or a relationship that is good but not extremely close whereas a cut off line represent a cut off or extremely distant relationship. The original protocol included a single administration of the instrument: the drawing was meant to capture a snapshot of the present situation experienced by family members. The current version features a double administration. In this latest version, the drawing representing the present family relational patterns is accompanied by a past (the family is asked to think of how their life was in a specific moment in the past, corresponding to a phase in the family cycle or a significant event) or future version (participants are asked to imagine themselves and their family in a specific moment in the future); both the moments should be sufficiently far away in time to imply significant changes and adjustment. The comparison between the two drawings helps to capture and better investigate the family functioning and dynamics as well as to appreciate the presence or absence of a transformative space where changes can be envisaged. As mentioned above, the drawing is evaluated on the basis of both process (e.g., who draws first, who decides where/what to draw, how family members communicate with each other, etc.) and outcome indicators (is everyone in the family represented in the drawing? Is someone missing? Are there any deletions?).
The Clinical Generational Interview (CGI), a clinical and psychosocial instrument for the assessment of family relations, was developed by Vittorio Cigoli and Giancarlo Tamanza after over 20 years of research and clinical practice (Cigoli & Tamanza, 2009). The specific aim of the Clinical Generational Interview is to investigate the quality of the generational plot, considering both the exchanges between generations (the intergenerational dimension) as well as the transmission of values, traumas, assets, and pains, across generations (the transgenerational dimension). The attention given to the study of generational plots makes the CGI a unique instrument within the literature on the topic and allows it to be used in several contexts, ranging from psychosocial research to clinical practice. The interview is constituted of 21 open-ended questions presented alongside with 24 paintings, 12 of which depict landscapes while the remaining show couples represented in different situations. The CGI is generally administered to the parental couple, the parental couple can, in fact, act either as a mediator between generations, thus fostering generativity or, on the contrary, as an obstacle, thus hindering generativity. The couple is in fact called to accept the responsibility, and the risk, of being generative, both towards the families of origin of each partner as well as towards the following generations. More specifically, the interview revolves around three axes: the axis of the origin, the axis of the couple relationship and the axis of the generational passage (the parent-child relationship). The first axis investigates each spouse’s relationship with his/her family of origin. Crucial themes, such as family rituals, rules, relationships with other significant figures during infancy are investigated in depth both throughout the recollection of specific episodes as well as through the narration of relevant feelings and emotions. The second axis of the CGI focuses on the couple relationship, specifically partners are asked about their couple’s history (e.g. how they first met, what attracted them about the other, etc.) as well as about their visions of the future. The aim of this part of the interview is to understand which elements (values, habits, rituals) tie the couple together and which unspoken, often unconscious, agreements have been made between the partner to preserve the bond. Moreover, this axis also takes into consideration the encounter of each partner with the family of origin of the other. The third, and last, part of the Clinical Generational Interview is constituted of only six open ended questions whose aim is to investigate the spouses’ expectations regarding their relationship with their children and their role as parents. Partners are also asked to review their family history reflecting over the most painful moment as well as on those situations that were capable of relaunching hope and trust. The use of a mixed methodology (graphic and verbal stimuli) allows researchers to access different mental and relational aspects that, if combined, might give a greater insight on each partner’s inner world as well as on the couple dynamics and core values. The Clinical Generational Interview makes use of a double coding system: typological and taxonomic. The typological classification entails two different levels, the first level allows an analytic coding of family bonds according to each of the axis of the interview (origins, couple, and passage). Each of the axis can, therefore, be labeled as either fecund, critical, or failing. More specifically, the labels “fecund” and “failing” define respectively the functional and dysfunctional form of family bonds whereas “critical” bonds are uncertain, ambiguous, somewhat blurred, with contradictory aspects. The second level of the typological classification, which can be called “synthetic”, regards the transmission of generativity. On the basis of our research, we can list six different forms of generativity: fecund, evolving, blocked, chaotic, degenerative, miserable. It seems important to explain how researchers empirically perform the analytic classification on each of the axis and how such a classification then leads to the synthetic coding. In order to explain the analytic classification of each of the axis, the second coding system (i.e., the taxonomic one) needs to be described as well. The taxonomic classification entails specific coding categories for each of the interview items, which are then associated to their corresponding type on the basis of the analytic classification system. Each lexical unit is therefore assessed both qualitatively (throughout the semantic categories of the taxonomy) as well as quantitatively (through the ordinal scale associated to bond type). In order to operate a synthetic coding of generativity, a combinatory logic considering both the form of the bond on each of the axis as well as the articulation between the axes themselves, need to be considered.