FAMILY ASSESSMENT VIA VIDEOTAPED INTERVIEW

FAMILY ASSESSMENT VLA VIDEOTAPED INTERVIEW

Frederick R. Ford. M.D.,’ and Joan Herrick’

T h i s paper i s divided into f ive par ts : the “Why,” the “What,” t h e “How,” of F a m i l y A s s e s s - ment, some d a t a and feedback, and some conclusions. W e s h a l l begin with t h e “Why.”

Why?

With a background of individual and family therapy exper ience we have b e c a n e in te res ted in t h e on-going evolution of t h o s e famil ies we h a v e s e e n i n treatment. In addition w e h a v e been tan ta l ized by t h e notion that fami l ies who are not and never will b e in treatment might a l s o benef i t from the theo- re t ical and pragmatic considerat ions in use by family therapis ts . A s a resul t of t h i s in te res t and a com- munication from Virginia Satir in 1964(2) i t occurred to u s that some t y p e of family a s s e s s m e n t a t regular in te rva ls might be of considerable u s e to families. W e thought, that i n order to be usefu l , t h e assess- ment had t o involve a minimum of time, a maximum of information of a particular type, and a maximum degree of feedback t o the family.

As t eachers of family therapy we had for s o m e years b e e n u s i n g a s t ructured family interview (Watzlawick, 1964)(3) as a way of ge t t ing a maximum amount of information in a s h o r t per iod of time. W e had a l s o been experimenting with t h e videotape recorder as a means of giving feedback to therapis t s in act ion and families in treatment; we had come t o the conclusion t h a t t h i s w a s the t rues t type of feed- back avai lable . (This conclusion w a s reinforced by the work of Alger and Hogan, 1969(1) o n t h e enduring e f f e c t s of videotape playback.) I t seemed natural therefore to consider marriage of a family t o a s t ruc- tured family interview with videotape recording and playback as the vehicle for family assessment . Un- fortunately the interview we had been using in teach- ing could not meet our criterion of a minimum time; therefore we set out to d e v i s e a n interview specif i - ca l ly for u s e with v ideotape recordings. B y the Fall of 1969 we had des igned our s t ructured interview and had acquired videotape recording equipment. We expected t h i s marriage of family and s t ructured in- terview to faci l i ta te the family’s abi l i ty to see and

1. .Dr. Ford is a psychiatrist in private practice in Berkeley, California.

2. Joan Herrick, M.S.S., is a psychiatric soc ia l worker and i s in private practice in P a l o Alto, California.

Dr. Ford and M i s s Herrick, co-directors of “Project V” in Berlteiey, are doing innovative work on the assessment of fami l i e s and family systems. Their studies m e video-taped recordings and are des igned for assessnient of normal famil ies who wish to learn about cotrxnunication patterns.

hear i t s own interaction, i t s own behavior, i t s own communication, and its abi l i ty t o comment o n a l l t h r e e ( d o e s t h e family h a v e an observ ing ego?). W e also thought that a family might make i t s own in- terpretat ions, and if there were t o b e conclusions or va lue judgements, t h a t they might share in t h e s e responsibi l i t ies with us .

What?

Therapis t s familiar with Fami ly Theory a re familiar with t h e emphas is on context. Although i t i s not total ly t rue, t h e question of “what” i s e s s e n t i a l l y a descr ipt ion of t h e context. T h e dic- tionary def ini t ion of context d o e s not adequately meet our needs: i t s a y s , “The par t of a d i scourse in which a word or p a s s a g e occurs and which h e l p s explain t h e meaning of t h e word or passage.” (Webster) Our def ini t ion h a s been enlarged t o inc lude “ the s i tua t ion within which communication o r behavior occurs tha t h e l p s to expla in the meaning of t h e communication or behavior.” By t h i s definition a family is a context, a videotape recording i s a con- text , a s t ructured interview is a context. T h e “what” of our family a s s e s s m e n t conta ins many things. W e s h a l l mention only those which w e feel a r e e s s e n t i a l or are unique:

1. Three hours

2. A s p a c e arranged in s u c h a way as to reduce or minimize c o l l i s i o n s or contaminat ions with “unrelated phenomena. ”

3. A room with a reasonable d e g r e e of light, air and sound proofing.

4. A suff ic ien t number of c h a i r s t o s e a t a l l the family members and the two authors and an occas iona l g u e s t in a modicum of comfort.

5. Videotape recording and playback equipment to record and play b a c k t h e s t ructured family in- terview.

6. Aydio tape recording and playback equipment to record and p lay back t h e verbal behavior of t h o s e present.

7 . A family or couple.

8. T h e referring person and/or a gues t .

9. T h e authors.

10. The structured interview.

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F o r our structured family interview w e s e t t l e d on s i x t a s k s :

1. Say who you are

2. Say what you most want t o change in your family .

3. A s a family, disczlss t h e a n s w e r s given t o t h e l a s t t a s k and come t o some conclusion.

4. Say what you most want t o change about yourself.

5 . Say what you most l ike about yourself .

6. Tell u s who may look at t h e videotape of family meeting.

We se lec ted t h e s e s i x t a s k s b e c a u s e of our exper ience with s t ructured interviews and videotape re cord ings.

Task Number F . “Say who you are ,” w a s the evolution of a s imilar quest ion we had asked while videotape recording in other s i tua t ions . I t is a request for a person to grapple with de l inea t ing himself and to make a bridge to the r e s t of t h e in- terview and the interviewers. (Several of our famil ies have s ta ted only their names.)

Tosk Number 2. “Say what you most want to change i n your family,” is a way of ask ing t h e family to tell what is wrong without t h e v a l u e judge- ment that i s often implied when t h e word “wrong” is used .

Task Number 3. “As a family discuss t h e answers given to t h e l a s t t ask and come to some conclusion,” l e t s us know whether t h e family members can ta lk t o e a c h other, whether or not they c a n ta lk about their s imilar i t ies and d i f fe rences , and whether they c a n come to a workable s y n t h e s i s of t h e var ious points of view. T h i s t a s k r e l a t e s and def ines their b a s i c abi l i ty to function as a reasonably effect ive and comfortable unit. I t g i v e s information about the abi l i ty of t h e family t o put its thoughts and fee l ings in to some kind of construct ive act ion.

Task Number 4 . “Say what you most want t o change about yourself,” i s t h e s a m e as T a s k Number 2 except that i t r e l a t e s to t h e individual; i f !]as to do with the hopes and dreams of each person and t h e view each h a s of t h e w a y s still o p e n to him for fur ther maturation. If we were to p h r a s e t h i s negat ively we would a s k , “Say what you most doubt about yourself.”

Task Number 5. “Say what you most l i k e about yourself,” h a s turned out t o b e the most anxiety provoking of all . T h i s , i s , of course, a way of f inding out what good things o n e is permitted to s a y about himself and a l s o inferent ia l ly what e a c h person is permitted to .;ay b y h i s superego. It tells

u s a great dea l about what i s permitted by t h e family and personal rules .

Task Number 6. “Tell us who may look at t h e videotape of th i s family meet ing.” Originally this was a simple request to t h e family t o give u s permission to show t h e tape t o other professionals . I t h a s turned out that t h i s is not regarded as a s imple reques t hu t is s e e n in different w a y s by e a c h family and often b y each family member. T h e way famil ies deal with t h i s t a s k te l l s us about t h e i r comfort in dea l ing with t h e outs ide world, their c a p a c i t y t o t rus t individually and severa l ly and their c a p a c i t y t o t a k e ac t ion i n reference to their thoughts , fee l ings and va lue judgements.

How?

‘(How” refers t o t h e process . It is t h e method of explanat ion of t h e way th ings come about. P a r t of the p r o c e s s is the making of connec t ions be tween what c a n b e or s e e m s to b e i so la ted data . T h e “how” is what c a u s e s things and c o n n e c t s t h i n g s to e a c h other. Transference, for example, i s a p r o c e s s (it may also b e a manifestat ion or a con- text , a ‘(what”). T h e quest ion then i s , (‘how’’ d o we put all the things i n the “what” together so that we come out with related da ta?

To s t a r t t h e family a s s e s s m e n t interview w e g ive a brief introduction and overview to t h e family. It is agreed between us that one of u s wil l run t h e camera and machinery; and the other will present and explain t h e t a s k s and the interview t o t h e family. The one who presents - the t a s k s also g i v e s t h e introduction and overview.

After introduction we proceed to t h e s t ruc- tured interview; the t a s k s are s ta ted as near ly as p o s s i b l e i n t h e words as written. Quest ions about t h e t a s k s a r e common. Whenever poss ib le the only an- s w e r given is a restatement of t h e task. Occas iona l ly the interviewer may make a remark s u c h as “I’m not s u r e you’re answering t h e question.” During some interviews it is n e c e s s a r y for t h e interviewer to interrupt and proceed on b e c a u s e of time and t h e ev ident fact that further answers wi l l not likely give further information. IYhile th i s is going on t h e inter- v iewer with ?!w camera h a s a difficult t ask . It is his job l o see !-h+ 1 1 1 ~ cquipmen? i s working sa t i s - factorily. For the actual filming he i s respons ib le for seeing thai Liic-. c 1 iit i a1 corn [nun i c at ion and interact ion are r e c o d e d . General ly we begin wi:h a wide a n g l e recording of t h e whole family ~ n d wait to see who wili answer wxch question List. iiiicn a member of t h e family announces himself h e i s focused on in medium range or close up. An at tempt is made to watch the res t of the family i n order that other act ion and react ion may b e recorded. U s u a l l y t h i s procedure is followed with each of t h e t a s k s . We try to get s o m e recordings of s p o u s e s ’ reac t ions

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while t h e other 1s ta lking and reac t ions of e a c h chi ld to e a c h parent . Frequent ly , we make some recording of t h e d ispos i t ions and u s e s of hands , feet and l imbs . Whether the camera man s u c c e e d s or riot in all h i s jobs, we have a weal th of information record- ed by t h e time t h e interview is completed.

When the structured interview is completed and t h e videotape i s rewound, we a s k t h e family o n e quest ion: “What will you b e looking and l i s ten ing for when ygu look and l i s t e n to yourself on t h e video- tape?” Our reason for doing t h i s s t e m s from experi- e n c e in our f i rs t two or three s t ructured interviews when family members were unable t o see anything different and/or were unable to comment on what they saw. The answer to this quest ion provides a bridge to the d i s c u s s i o n that follows. In the event the family agrees tha t they don’t know what they wil l b e looking and l i s ten ing for, we d e s c r i b e a few of t h e usual reac t ions .

T h e videotape is t h e n played; if p o s s i b l e i t is played without interruption. We have noticed in famil ies with chi ldren under the a g e of ten tha t t h e anxiety and exci tement a re so great that interruptions a re inevitable (we have had s imilar exper ience in schools) . After viewing, we a s k e a c h person what h e s a w and heard. We try t o check out with e a c h family member as to whether h e s a w and heard what h e sa id he’d b e looking and l i s ten ing for. T h i s d i s - cuss ion of ten f lows over in to assumptions and value judgements; however, our emphasis remains on in- dividual percept ions. We try not t o inject any of our observat ions or opinions into the p r o c e s s a t t h i s point.

After a ten to f i f teen minute break, during which the videotape is rewound, w e resume with any- thing tha t is unfinished from the foregoing d iscuss ion . ’ T h i s l e a d s into a few comments o r observat ions by one of t h e interviewers . T h e s e comments a re in- evi tably different, a t l e a s t in the i r language, from those of t h e family; t h i s resu l t s in some quest ion or disbel ief of the part of one or more family members. With these ques t ions or s c e p t i c i s m s in the forefront we again look a t t h e videotape. During the second playback w e interrupt and/or replay any par t when- ever anyone wishes t o comment. T h i s l a s t replay of the videotape h a s seldom been completed. We have on occas ion s p e n t as long as an hour looking at and d iscuss ing one f i v e minute segment of the tape .

All of ou r interviews have ended a s the resul t of the l imits of t ime. If p o s s i b l e we conclude with emphasis o n s o m e o n e typical family pattern of communication or behavior . Before we s e p a r a t e from t h e family an expl ic i t agreement is made with them about our intention to s e n d a written report; we arrange with them to g ive u s feedback about any spec i f ic u s e they make of mater ia l from the a s s e s s m e n t in- terview and/or the report.

T h e reports to t h e family are made after a complete review of t h e audio and videotapes. Because of t h e r ichness of d a t a , many dec is ions have to b e made about what mater ia l t o include and even more about what material t o l e a v e out . In addition we find ourselves searching for the language that will b e most understandable t o e a c h family. T h i s s e a r c h h a s , usually, begun during t h e interview i tself and i s researched and corrected during t h e review of t h e t a p e s .

Data and Feedback

W e have s e e n a to ta l of twenty-one families/ couples . Eleven of t h e s e were in therapy a t t h e time of the assessment interview. T h e therapis ts who referred t h e fami l ies /couples were at a therapeut ic impasse; that i s , t h e therapis t and fam ily/couple were feel ing s t u c k in some way and at t h e point of termination. One of t h e s e famil ies terminated as a direct result of clar i f icat ion stemming from the in- terview. Sevenbecame m o r e actively involved in and committed to therapy. T w o have remained on the fence about committing themselves (approximately three months la ter) and one family was s e e n so recently tha t it is too soon to te l l i f their c o m m i t - ment t o therapy h a s been affected. Two other famil ies were j u s t s ta r t ing therapy: s i n c e both involved difficult s i tua t ions t h e t h e r a p i s t s fe l t the a s s e s s m e n t would provide a background and foundation for treat- ment. Of these , o n e discont inued after five inter- v iews and the o ther became act ively involved and committed to therapy.

Of t h e e i g h t famil ies /couples who were not in therapy, three were former pat ients of one of the authors, two were co l leagues’ famil ies , and three were s e n t by c o l l e a g u e s as a result of interest in th i s project.

With o n e except ion t h e therapis t s have been e n t h u s i a s t i c in their react ions t o t h e a s s e s s m e n t and t h e report. F o r example, one therapis t h a s sa id , “ i t i s usefu l to m e t o learn more about t h e family rules and sys tem, and to have t h e organized d a t a for reference.” Another therapis t s a i d that t h e report “helped clarify t h e i s s u e s and provides something so l id to work from.”

We had expec ted that therap is t s would m a k e u s e of and b e interested in this a s s e s s m e n t ; however, we were not prepared for t h e e n t h u s i a s t i c response and var ied u s e s t h e famil ies have made of t h e inter- view and t h e report. Feedback on the interview inc ludes the following: three months, and o n e year la ter , two men reported their s u r p r i s e and increased self-esteem from s e e i n g t h a t they were “not as ugly” as they ha l thought; two women s a w themselves a s family members for t h e f i rs t time rather than as the family. F o r s e v e r a l famil ies t h e assessment marked the beginning of a p r o c e s s of family contemplation, and one family reported that now they could look a t “what can b e worked on” rather than “what’s wrong.” One family went home fron t h e interview and spent

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the whole weekend ta lk ing about i t . Some u s e s of the report were: one couple u s e s t h e report as a focal point whenever there i s s t r e s s i n t h e family. The “black and white” quality of the report g a v e one family a foundation for d i s c u s s i n g family affairs 4. T h e a s s e s s m e n t interview i s a useful way of rather than their usual arguing. Severa l f arnilies consul t ing with therapis t s about the i r therapy. understood operat ions of t h e family as a sys tem for the f i r s t time. Some fami l ies specif ical ly and defi- 5. T h e a s s e s s m e n t interview is worthwhile as a nitely set out t o c h a n g e unwanted family ru les . d a t a col lector t o further our knowledge of the

3. T h e a s s e s s m e n t interview is a usefu l instrument for consul ta t ion with t h e r q i s t s about famil ies in treatment.

Conclusions

Famil ies , whether in therapy or not, find t h e a s s e s s m e n t interview and report of u s e i n a var ie ty of different ways for the promotion of individual and family g o a l s .

The a s s e s s m e n t interview promotes family in- volvement in therapy that has in some s e n s e already begun I

operat ion of family sys tems.

References

1 . Alger, I . and Hogan, P. , “Enduring Effects of Video- tape Playback Experience on Family and Marital R e - lationships.”Amer. 1. Orihopsychiotry, 39: 86-96, 1969.

2 . Satir, Virginia. Personal communication. 1964.

3. Watzlawick, P . , “A Structured Family Interview,” Fam. Proc. 5: 256-271, 1966.

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