Requesting clients to complete assessment instruments without a clear use in therapy or specifically authorized research is unethical. Consequently, assess- ment instruments must be brief and clinically useful. In a training facility, assessment data are especially useful in supervision to connect the theoretical base in assessment and intervention. In independent practice, assessment data should be utilized in creating treatment plans and shared with family members.
A suggested protocol for utilizing family assessment in the course of ther- apy includes these steps:
1. The family therapist should plan an intake procedure that includes some standardized method of self-report family functioning (this author uses
the SAFE) and an assessment of family violence (a brief violence scale/
clinical observations).
2. When clients come into the office, they must first sign a written informed consent.
3. Clients then complete any written family functioning assessments.
4. Assessment continues throughout therapy, with regular documentation of family functioning in the GARF completed by the therapist.
5. Dynamic assessment guides the therapy process throughout by using clinical observations, the family genogram, and children’s instruments to plan interventions and share data for goal setting with the client family.
CASE EXAMPLE
The following family story illustrates how family assessment tools can guide the process of therapy to a successful improvement in family functioning.
Family Chaos
This family was referred to the author’s office to help resolve parental access conflicts blocking the finalization of divorce, which had been ongoing for 2 years; this was the second time the parents had separated and filed for divorce.
The mother was now requesting supervised access for the father to the 6-year- old son, with accusations of family violence. (This was investigated and found to be unfounded during the second divorce filing; the father had no attorney on the first filing charges and the mother did obtain a protective order against him. She had set him up to violate this and then charged him with violation, resulting in his being on probation.)
During the first attempt at divorce, a social study had been conducted that recommended joint managing conservatorship (custody), with the father establishing primary residence because of the mother’s history of psychologi- cal disturbance. The mother had revealed to the father that she was molested by her father, but had never been in therapy to resolve the trauma. She was completing her Master’s degree in counseling when ordered into the program.
The father admitted that he had historically had a problem with alcohol and was currently living with his parents because of financial difficulties resulting from the alcohol problems. The social study on the second divorce filing was almost finished when they came into therapy.
Family Assessment Process
The consent forms (Step 2), SAFE (Step 3), and a family violence abbreviated questionnaire based on the Conflict Tactics Scale (Step 3) were completed at
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CHILDAND FAMILY ASSESSMENT 177
the office before the first therapy session. During the first session, the SAFE cartoons (Step 5) were discussed with the son in a private interview. The genogram (Step 5) was used during the first session with all three family members present. In addition to structural information, family-of-origin rules about divorce and conflict management were identified on the genogram. The son added his own family drawings on the bottom of the easel page, including parents, grandparents, and two of his mother’s children from a prior marriage who did not have primary residence with her. At the conclusion of the session, the therapist assigned the GARF score on the GARF Profile Chart (Step 4). Observational data were revealed during the session and by outside faxes.
Assessment Results and Utility
Because of the history of domestic violence charges, screening for family violence was the first goal of assessment (Step 1). The family violence ques- tionnaire showed very consistent reporting from both parents: significant physical conflict had occurred during their living together, with each accusing the other of being the primary perpetrator; however, the physical assaults had stopped since the separation 2 years ago. The SAFE final item under the mari- tal relationship assessment provided more confidence in safety (Step 5). The father reported extreme control and submission in the relationship, but the mother reported a neutral response. If the accused abuser had reported “both work together equally” and the supposed victim had reported “one controls and the other submits,” the therapist would have been more inclined to investigate safety further.
Surprisingly, the mother scored the marital relationship mid-range on all items of the semantic differential. The father scored the marital relationship on the low side with one exception to the lowest score. Both scored the relationship between themselves and the son as somewhat positive but not perfect, although the mother indicated more power struggles than did the father. The father scored his relationship with his own parents as generally good; the mother scored her relationship with her parents as generally bad. It appeared that the mother perceived the relationship with the father as better than the relationship with her parents, despite how bad the marriage was. The son’s first response to the SAFE cartoon was to select the competent family as his family. Later he reported that his parents did sometimes fight like the dis- cordant family.
The genogram (Step 5) revealed that the mother had a prior marriage in which two children had chosen to live with their father and see her infrequently. Although molestation was not revealed in the joint session, the mother did indicate that conflict was handled by her mother submitting to her father’s controlling behavior. The father’s family-of-origin family resolved
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conflicts by talking things through, although his father traveled extensively and his mother, the primary caretaker, did not work outside the home.
Clinical observation (Step 5) was very revealing in this family. The mother had said that she could not be in the same room with the father, but attorneys did not back that up. She seemed quite comfortable in the same room, but did insist that she leave the office first and be given at least 5 minutes before the father left. This action appeared to be more of an attempt to convince the therapist of safety fears than actual fears for safety. Outside the sessions, the mother repeatedly faxed accusations of the father physically abusing the son and her calling CPS (i.e., the son had a bruise on his knee after spending the weekend with his father or the son said he bumped the end of the bed when getting up to go to the bathroom, assuring his mother that his father was neglectful). The son’s reaction with both parents in the room was obvious anxiety and no talking at all. After his private interview with the ther- apist, he was able to share openly with his parents that he needed for them to stop fighting, be best friends, give him sweet dreams, and not let him watch scary movies.
At the conclusion of each of the six sessions with this family, the therapist recorded the GARF scores (Step 4). Scores progressed as follows:
• Interactional changed from 20 at the first session and 25 at the third session a month later to 30 at the final session 6 weeks later.
• Organizational changed from 30 at the first session and 35 at the third session to 40 at the final session.
• Emotional Climate changed from 10 at the first session and 30 at the third session to 35 at the final session.
• The son’s openness with the parents seemed to have a big impact on them.
Although many contaminations kept the functioning level low, the emo- tional climate did seem to level out with the organization and interaction functioning.
Outcome for the Family
Although family functioning remained low, the parents were able to reach significant agreements in the later sessions, which relieved some of mother’s anxiety regarding an abusive father. Guidelines for assuring no drinking or illegal drugs when either parent was with the child were agreed to. Parenting guidelines regarding bedtime, parental exchange, and mutual support of the son’s activities helped structure this family for more effective divorced coparenting. Parents worked out a plan for the father to take possession of his personal property, which had been stored in the mother’s house for 2 years and had possibly been stolen during a burglary. This concrete action seemed
CHILDAND FAMILY ASSESSMENT 179 to free them up to move forward with the divorce. Further litigation was avoided and both parents believed that their son could have “sweet dreams.”