Fam Proc 2:175-181, 1963

BOOK REVIEWS

Family Worlds, A Psychosocial Approach to Family Life, by Robert D. Hess and Gerald Handel, University of ChicagoPress, Chicago, 1959. 306 pp. $5.00.

The major portion of Family Worlds is devoted to an analysis and description of the shared life within five differentfamilies. These families were chosen from a group of thirty-three "normal" families because, in the opinion of the authors,they represented the reasonable range of variation for families present in the sample and in the universe of "typical"American families. The authors evaluated families as "typical" on the basis of the most general understandings about "themajor social, cultural, and psychological circumstances which influence ... family interaction and activities ...."

In format, this book represents the case history method of analysismuch like that used by Oscar Lewis in his bookabout five families. The advantages of the method are: the qualitative richness of the data are preserved, the inquiringreader may grasp all the nuances of the problem as originally seen by the researcher, and the aspects of the problemunrecognized by the researcher may be grasped by others who examine his data. The disadvantage of the method is: theresearcher is tempted to evade the responsibility of selection and content analysis of the data, leaving the reader to evaluatehis field notes and so to do his work for him.

Fortunately, the authors of Family Worlds have not left the reader entirely without theoretical formulations to guide him.For example, in their discussion of family organization, they show a clear recognition of the paradox that family life hasboth centrifugal and centripetal tendencies. The necessity to keep the family members together, and the concurrentnecessity to eject themeither into workaday life or to form new familiesis called "the underlying conditions ofseparateness and connectedness" by the authors.

Although some aspects of this integral strain in the family have already been discussed by theorists, few are sufficientlysophisticated to grasp as much of the problem as the authors discussed here. For example, in psychological or psychiatricstudies, researchers focus on one or the other end of the extreme, not perceiving the problem as one which runs throughfamily life. The families where members are cast adrift and the families where members are pathologically bound togetherin closeness are examined. Then again, in anthropological or sociological studies, the tendency is to focus on theinstitutional ways through which these strains are supposed to be accommodated: the rites whereby the adolescent istransformed into an adult and married off; or the rites to mitigate the agonies of bereavement are often described in order toexplain how society helps individual families solve these problems. None of these explanations, however, refer to actual,specific families, nor do they tell us how well, or how poorly, families are served by the institutional means at theirdisposal.

In their study, Hess and Handel have shown that highly successful adjustments to problems engendered by the necessityof offering security and companionship in the family present new problems in the promotion of independence and initiativeamong family members (see chapters 2 and 6). Conversely, allowance of great independence presents particular difficultieswhen comfort or emotional support is needed (see chapter 4). In the resolution of daily incidents pushing family membersapart or together, families which avoid focusing at either extreme, constantly must re-address themselves to resolvingtensions arising from absence of a rigid policy (see chapter 5). The authors, then, are to be complimented on theirendeavors to face this paradox of function-dysfunction more squarely than is usually the case.

Hess and Handel have developed a variety of categories for comparing families so that they may deal with the question ofhow basic tensions between separateness and connectedness are resolved. The most thought provoking are these three: themanner in which a family draws boundaries between itself and the outside world, the nature and kind of reaffirmation forself-images offered family members by one another, and the manner in which family members draw boundaries betweenthemselves.

The first category suggests that the "cell" metaphor for the family may be useful. Each family must take account of socialpressures. For example, the family must meet expectations from others that it can act as a unit and that it will takeresponsibility for all members when necessary, in all types of situations ranging from catastrophies such as disabling illnessto routine matters such as entrance to school, maintenance of reasonable health and cleanliness by community standards,and so on. It may be assumed that this structural problem is constant; what becomes interesting is the range and variety ofsolutions which families can find.

The second category, conforming to social behaviorist theories of G. H. Mead and others, stresses the importance ofcongruence of images. Since socialization into society and development of personality are effected within the family, aneffort should be made to assess these processes. Researchers have been at a loss to make this assessment; these processesare a constantly occurring part of the fabric of life. Consequently it has proven extremely difficult to isolate and identifythem except in cases where severe pathological disorders are present. The authors suggest a possible answer to this

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problem. Investigation of individual personality has neglected the interaction processes which mould the self. The authorsseek to observe the degree of congruence between an individual's self-image and the appraisals of him made by others inthe family. In this view it is assumed that the degree of congruence between self's image and other's image of self is anindicator of the nature, and history of family interactions. Cooley's idea about the nature of the "looking glass self" and itssignificance for individual actions is broadened to include the ongoing interaction of a family group.

Current family literature suggests that psychic development and emotional stability are crucially influenced by theamount of freedom allotted an individual within the family. At the same time, this literature suggests that emotional supportwithin the family and comfort for the individual are also crucial. The third category presented by Hess and Handel discussesthe problem of separateness and connectedness in terms of the boundaries between family members. This third category isan orthodox theme in the literature and usually is the main substance of the theoretical presentation when it appears. In thispresentation, it takes its place as one element in a more sophisticated and fruitful theoretical system.

According to the authors, each family's adjustment and response within these three categories helps to structure ordelimit the "family theme." The problems of boundary maintenance and individual socialization are problems of socialorganization. The particular content of a family's lifethe themes which are drawn from the experiences of the parentalmembers and the exigencies of life conditionsgive each family its culture.

This theoretical approach to the study of the family gives promise of great usefulness in the problem which must be facedsooner or laterhow to create a typology of families. Accordingly, the authors are to be commended for their insight inbeginning on what will no doubt be a monumental task. It is, perhaps, unfortunate that they have been so ambitious andhave aimed, in this work, "to describe and understand families as units while concomitantly relating the personalities ofcomponent members to the unit." It may well be that they would have succeeded in accomplishing even more than theyhave if they had limited their interest to what they have done bestanalysis of the family as a unit. One cannot help butwish that the categories which were developed in the opening theoretical sections had been more rigorously integrated intothe organization and content analysis of the family histories.

In spite of these reservations, Family Worlds is a work which is so full of theoretical insights, and a work so interestingin the methodological problems it has presented and raised, that every researcher concerned with this area of investigationshould read it. There are few if any comprehensive works on the family available today which combine so sophisticated atheoretical presentation with as much systematic empirical research.Arlene Daniels, Ph.D.

Families in Treatment, by Erika Chance, Basic Books, New York, 1959. 234 pp. $5.50.This work is a report of a research project in which thirty-four middle class, predominantly Jewish families were studied

as they went through therapy in a child guidance clinic in Philadelphia.The families in the project consisted of both parents plus a child who was the primary patient. The entering complaints

for the children covered a wide range, although psychosis, mental deficiency, and central nervous system involvement wereruled out. The children were mostly boys and were between six and thirteen years of age.

To an advocate of conjoint family therapy, the kind of treatment studied in this book will seem old fashioned. Mother andchild were each seen in individual therapy, while most of the fathers were seen in group sessions. The orientation of thetherapists was primarily Freudian.

The data for the study were collected during semi-structured review sessions held at approximately the third, sixteenth,and thirtieth therapy sessions. Data from the parents were obtained by means of a semi-structured interview followed bytwo Q-sort tasks. The interview was designed to elicit statements about self and child. With the Q-sort, both parents wereasked to describe themselves; then mothers were asked to describe their therapists. (Since most of the fathers were seen ingroup therapy, they were not asked to describe their therapists.) The review sessions for each child consisted of asemi-structured play situation, but no Q-sort assignments.

Before each review session, each parent's therapist was asked to predict what his patient was going to say about himself.Immediately following the review session, each therapist was asked to predict what his patient was going to say abouthimself at the next review session. After the last review session, the therapists predicted what their patients' selfdescriptions would be one year hence.

A simplified variant of the interpersonal "circle" developed by Freedman, Leary, Ossario, and Coffey was used to analyzethe data. All descriptions of interpersonal experience were rated as positive active, positive passive, negative passive, ornegative active. In addition, the author attempted to define operationally and to study certain "intrapsychic" processes suchas projection, conflict, positive identification, denial, and immaturity.

The questions which Doctor Chance sought to answer in her study were based on a review of the diagnostic andprognostic statements made by the therapists about the families in the project. These questions can be grouped convenientlyinto three categories. The first has to do with the nature of the interpersonal relationships and experiences found in the

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families at the beginning of treatment. Here, the concern was with examining the role relationships within the family, thedegree to which each member rejects himself, which type of interpersonal experiences seem most conflict laden, and thenature of the defense mechanisms employed by the fathers and mothers. The answers to these questions were sought byanalyzing the data from the third therapy session (the first review session).

A second group of hypotheses which were dealt with in the study had to do with the nature of the psychotherapeuticrelationship and its relationship to the course of treatment. This aspect of the study was based on data from just the mothersin the families and the six female social workers who served as their therapists. Attention was directed to both the patient'sview of the therapist and the therapist's expectations of the patient. A comparison was also made between the three mostexperienced therapists and the three most inexperienced.

A third aspect of the investigation had to do with the nature of the changes that took place in the family constellationsduring the course of treatment. Here, those family patterns which were in evidence at the beginning of treatment werere-examined for signs of change.

Perhaps the major weakness of the study is the fact that it is based completely on reports by individual family members totheir therapists about themselves and their relationships with other family members. This does not seem to the presentreviewer to provide a fair test of many of the clinical hypotheses that Doctor Chance attempts to deal with. For example,one of the hypotheses derived from the therapists' diagnostic statements was that the father is the most passive member ofthe pathological family. This was tested by seeing if the fathers tended to talk more about relationships in which they werepassive than did either the mothers or children. To base a definition of passivity on whether or not a person talks aboutrelationships in which he is passive seems highly questionable, since such a definition overlooks the blind spots in thepatient's point of view.

A related point concerns the seeming confusion in regard to the meaning of the quadrant scores for the various familymembers. Throughout the book, they are variously called "needs," "areas," "experiences," "relationship experience,""preoccupations," and "concerns." When a family member talks extensively about relationships in which he is passiveaggressive, for example, does this mean that he has a need to be this way, a concern about behaving this way, or both? Thegreat unknown, of course, is what the relationship is between these scores and what "really" goes on in the everydayinteractions of the family members.

In setting up the hypotheses to be investigated, Doctor Chance attempted to translate the questions and assumptions ofclinicians into researchable terms. As with all translations, there appears to have been some distortion and loss of meaning.The operational definitions of the following terms seem particularly open to question: Immaturity in parents is defined asthe degree of similarity between the parents' and the child's self descriptions. Projection in the parent is defined as thecorrelation between a parent's self criticism and his criticism of his child. Defensiveness and denial are measured bycomparing self descriptions in the interview with Q-sort self descriptions. One wonders to what extent these measureswould correlate with clinicians' ratings or other independent measures of the same thing. The scores based on definitionssuch as these are rather high level statistical abstractions that are far removed from the actual behavior taking place withinthe families.

Another limitation of the study stems from the use of a sixty item Q-sort which appears to be filled with loaded items.The lack of sensitivity shown by this test may well have been a function of the particular phrases chosen to represent eachof the four variables in the interpersonal "circle." The phrases used presented the subject with extreme examples of each ofthe 4 types of behavior, so that he was forced to operate within too narrow a range of choices.

In spite of its shortcomings, the investigation demonstrates the application of some clever and resourceful researchstrategies. Doctor Chance's approach seemed to be most appropriate for the study of changes in individual therapy, as wasthe case when she studied the therapy of the mothers. Here, the results showed some clear-cut shifts in what the mothershad to talk about and how they talked about themselves in the course of therapy. Here, she was able to demonstrate someinteresting differences between experienced and inexperienced therapists. It is questionable, however, that this same basicmethodology is adequate for the task of studying relationships within the family constellation before and after treatment.

This reviewer found Families in Treatment difficult to read because of the manner of presentation and the organizationof the material. The book would have been easier to read if the author had not attempted to make it be more than just aresearch report. According to Doctor Chance, "The major thesis of this book is that a combination of clinical and researchdescriptions of families in treatment contributes more to our understanding than the separate use of either." She tries toprove this thesis by devoting Part I of the book to a discussion of the differences between the approaches of the clinicianand the researcher and then following through by comparing clinical descriptions with the research findings throughout therest of the book. Unfortunately, this attempt is likely to distract the reader from following the complexities of the researchproper. In the opinion of the reviewer, most of Part I of the book could have been better used as the basis of a separatepaper, and most of the clinical material appearing throughout the book could have been better relegated either to a separatechapter at the end or to the appendix.

In spite of the attempt to interweave the clinical and research viewpoints, the book will probably not appeal to the

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clinician who has little interest in research methodology. However, those interested in the problems of research inpsychotherapy should find Families in Treatment worthwhile reading.James Terrill, Ph.D.

Mental Health Book Review Index, American Foundation for Mental Hygiene, New York. Volume II, 1962. 66 pp.$3.00.

The purpose of the Mental Health Book Review Index is simple enough. It is to list articles in the mental health field thatdeal with books, indexes or book review sections and to note comments on monographs made in journals by editors,authors or readers. This simple purpose has led to seven editions of the index since its inception in 1955. There have been2,383 titles listed in the seven volumes of the index. This noteworthy effort is achieved without financial support and, as theeditors comment, its main capacity to function derives from harnessing human brain power by the agency of scholarlyexchange.

The index lists 170 journals published in the English language, 145 of which are still current. A fascinating statistic isthat these journals have published in the past seven years almost 24,000 reviews dealing with some 10,500 books andpamphlets. The Mental Health Book Review Index selects books which have three or more reviews for inclusion within theindex volume. Titles are repeated in subsequent volumes whenever three or more reviews appear representing the book. Inthis way the selections in this index are chosen essentially by a vast array of book reviewers throughout the country.

There are several sponsors for the Mental Health Book Review Index: World Federation for Mental Health, InternationalCouncil of Psychologists, American Foundation for Mental Hygiene, and Research Center for Mental Health, New YorkUniversity. The Chairmen of the Editorial Committee are Ilse Bry, 317 West 105th Street, New York 25, New York andLois Afflerbach of the Paul Clabber Library, Queens College. There is a committee of consultants of which the chairman isRobert R. Holt, Director of the Research Center for Mental Health, New York University, and there is an impressive list ofconsulting librarians and editorial assistants. All of these people work together to turn out a volume which is certainly ofgreat use to anyone exploring mental health publications for purpose of research and education. The information-filledpages quickly give the reader an impression of what is important and tell one where he can get further critical opinion abouta given title. I believe that the index is vital and certainly recommend it. Subscriptions are $3.00 annually, checks payableto Mental Health Book Review Index. Subscriptions and remittances should be sent to Miss Lois Afflerbach, The PaulClabber Library, Queens College, Flushing 67, New York.Carl Peters, M.D.

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