Selected family therapy outcomes with Bowen, Haley, and Satir

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Dissertations, Theses, and Masters Projects Theses, Dissertations, & Master Projects

1993

Selected family therapy outcomes with Bowen, Haley, and Satir Selected family therapy outcomes with Bowen, Haley, and Satir

Joan Elizabeth Winter College of William & Mary - School of Education

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Recommended Citation Recommended Citation Winter, Joan Elizabeth, "Selected family therapy outcomes with Bowen, Haley, and Satir" (1993). Dissertations, Theses, and Masters Projects. Paper 1539618702. https://dx.doi.org/doi:10.25774/w4-qf2g-mf76

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https://dx.doi.org/doi:10.25774/w4-qf2g-mf76

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207

Table 4.20.2

Non-Engaged Groups: Identified Client Demographics

Variable Bowen Haley Satir All

IDENTIFIED CLIENT

AGE (Mean) 14.8 15 15 14.9

RACE q = 5CMCMIIa n = 4 n = 31

White n = 2 h =18 n = 2 11 = 22

40% 81.8% 50% 71%

Black H = 3 n = 4 11 = 2 n = 9

60% 18.2% 50% 29%

Other n = 0 n = o U = 0 n = o

GENDER n = 5 ii ro ro n = 4 11 = 31

Males n = 4 n = 12 n = 3 11 = 19

80% 54.5% 75% 61.3%

Females n = 1 n = 10 n = 1 n = 12

20% 45.5% 25% 38.7%

FAMILY LIVING SITUATION n = 5 H = 22 n = 4 n = 3i

Both parents

C\JnC| n = 10 n = 0 n = 12

40% 45.5% 38.7%

Blended n = 0 B = 4 H = 1 H = 5

18.2% 25% 16.1%

Single parent n = 3 H = 7 11 = 2 n = 12

60% 31.8% 50% 38.7%

Other D = 0 n = 1 11= 1 n = 2

4.5% 25% 6.5%

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

595

This study has attempted to fill the research gap between prior family

therapy outcome studies which have focused primarily on eclectic approaches to

treatment, or only one type, or school of therapy. Therefore, this research has

addressed the limitation set forth by Gurman and Kniskern (1981b) that little

research had been conducted on "pure" family therapy models. By having the

direct participation of three vanguard theorists in the field, including Murray

Bowen, Jay Haley, and Virginia Satir, this study has been able to generate and

analyze data regarding the differences between distinct schools of family

therapy. Despite a substantial amount of research, Jacobson (1985,1988)

asserted that previous outcome studies have not rigorously evaluated family

therapy. The present study has attempted to analyze a number of issues not

previously addressed in the literature. In particular, the process of clinical

Engagement, Dropout, and Completion, as well as Satisfaction with Treatment,

Locus of Control, and Family Functioning have been evaluated. Further, the

addition of a comparison group has strengthened the results of this study.


APPENDICES


APPENDIX A

ROTTER INTERNAL-EXTERNAL

LOCUS OF CONTROL SCALE


PLEASE NOTE

Copyrighted materials in this document have not been filmed at the request of the author. They are available for consultation, however,

in the author’s university library.

598-602 604-611

University Microfilms International


APPENDIX B

FAMILY ADAPTABILITY AND

COHESION EVALUATION SCALES

(FACES)


APPENDIX C

CLIENT INFORMATION FORM


Please Leave Blank

C N :_____________

F I : ____________________

T : _____________________

I. INSTRUMENT NAME: CLIENT INFORMATION FORM

II. ADMINISTRATION TIMING: BEFORE TREATMENT

III. DATE OF INTERVIEW/ADMINISTRATION: __________________________

IV. COMPLETED BY: (FULL NAME OF PROBATION COUNSELOR)

(FULL NAME_____________________________________________________ )

V. COMPLETED ABOUT: (FULL NAME OF IDENTIFIED CLIENT)

PEOPLE PRESENT DURING INTERVIEW (CHECK ALL THAT APPLY):

MOTHER _____

FATHER _____

IDENTIFIED C LIE N T_____

SIBLINGS _____

OTHER _____

(SPECIFY): ___________________________________________________


1

CLIENT INFORMATION FORM

A. DEMOGRAPHICS1. Race: ____ White _____ Black O t h e r _____________ '

2. Sex; ____ Male _____ Female

3. Current Living Situation; Both Natural Parents Blended (one step-parent) Single or Separated Parent Other ______________________

4. Income and Occupation:Number of Jobs

Yearly Income Type Of Work in Last 5 Yrs.Father______ ______________ _____________ _______________Mother______ ______________ _____________ _______________IdentifiedClient______ ______________ _____________ _______________

5. Current Offense of Identified Client:(Please give VAJJIS code)

♦


2

B. HOME ENVIRONMENT

1. Location of Residence: ___ Urban ____ Suburban Rural

2. Type of Residence;_______________ ___ Home (___own rent) Apartment _____ Trailer

Other : ________How long has the family lived at the current address? _____________________________ yrs.How many times has the family moved in the past five years? (enter in all those' blocks that apply) .

Less than 75 miles?_________Greater than 75 miles?and changed school districts

5. How many of the following rooms does the residence have?Bedrooms _____Bathrooms _____Family Room _____

6. Does the identified child share a room? If yes, withwhom is the room shared?_______________________________________

7. How many people live in the house?______________________________


3*• C. FAMILY PROFILE

1. Please list all the members of the nuclear family and fill in the following information. A nuclear family could include: father, mother, biological and step children, grandparents. They need not be living in the home.FIRST NAME SEX AGE NATURAL=N LIVES WITH LASTAND RELA- MALE* OR STEP=S FAMILY GRADETIONSHIP M/FE- YES,NO in_______________ MALE*F________________ ________________ SCHOOL

2. Are there any other relatives living in the home? (List full name and relationship)NAME RELATIONSHIP

D . CRIMINAL HISTORYPlease list the members of the family, including grandparents, who have been involved in the criminal justice system as either a juvenile or an adult.

TYPEFULL NAME RELATIONSHIP AGE AT ONSET OF OFFENSE DISPOSITIOt

&


4

E. COMMUNITY INVOLVEMENTPlease indicate the number of hours per month, each of the listed family members is involved with the following community activities:

ACTIVITY MOTHER FATHER IDENTIFIEDCHILD

CHURCH ________ HRS/MO ________ HRS/MO. _______ HRS/MO.SOCIAL OR ATHLETIC CLUBP.T.A.POLITICALORGANIZATIONVISITINGFRIENDSVISITINGRELATIVESRECEIVINGFRIENDSATHLETICEVENTSCULTURALEVENTSOTHER:


5. If you needed help in the future, would you return to this Family Institute? (Read this) Give me a number from one (1) to five (5), with 1 = definitely No

3 = maybe, and 5 = definitely yes ,

Interviewer; Circle Response1 2 3 4 5

Definitely Maybe DefinitelyNo Yes

6. Do you feel your family was prepared for what to expect in family therapy?

Yes _____No _____ If not, in what way was your family unprepared

7. In your opinion, which family member(s) wanted to continue treatment the most?Checklist for interviewer (Do not read):

Mother Father Step-Mother Step-Father Identified Client_____ Sibling (Name: ____________ Grandparent (Name; _____________ Other (Name and relationship

Comments:

)))

4

5-


F. SERVICES INTERVENTIONInstructions;For those problems or professional services that any member of the family has received within the last two years, please complete the information for each problem, (see example below)Type of Problem: alcoholismIdentified Client: father Agency: Alcoholics AnonymousType of Treatment: GroupLength of Treatment: 3 yrsCost: Monthly 5 None

Total $ None Still receiving service: X Yes __ No

1.. Type of Problem:Identified Client: Agency:Type of Treatment:_ Length of Treatment^ Cost: Monthly $

$TotalStill receiving service:__Yes

No

4.Type of Problem:Identified Client: Agency:Type of Treatment:__Length of Treatment:_ Cost: Monthly $

$ “TotalStill receiving service:__Yes

No2. Type of Problem :_

Identified Client: Agency:Type of Treatment:__Length of Treatment:Cost: Monthly $ ___|

Total $Still receiving service:

NoYes

5.Type of Problem:Identified Client: Agency:Type of Treatment:__Length of Treatment: Cost: Monthly $ _

Total $Still receiving service:

NoYes

3. Type of Problem:Identified Client: Agency:Type of Treatment: Length of TreatmentCost: Monthly $ ___

Total $ ___

6 .Type of Problem:

Still receiving serviqe: No

Yes

Identified Client: Agency:Type of Treatment:______Length of Treatment:____Cost: Monthly $ ____

Total $ ___Still receiving service:

NoYes

7. Additional'Comments:


APPENDIX D

CLIENT PROGRESSION LOG


THE CLIENT PROGRESSION LOG HAS BEEN REMOVED BECAUSE IT

CONTAINS CONFIDENTIAL INFORMATION.


APPENDIX E

DROPOUT TELEPHONE QUESTIONNAIRE


Please Leave Blank

CN: _____________

FI: ____________________

T: _____________________

I. INSTRUMENT NAME: DROP-OUT TELEPHONE QUESTIONNAIRE

II. DATE OF TELEPHONE INTERVIEW: _______________________________

III. COMPLETED BY: (FULL NAME OF INTERVIEWER):

(FULL NAME___________________________________________________and

TELEPHONE NUMBER OF INTERVIEWER:

)IV. COMPLETED ABOUT: (FULL NAME OF IDENTIFIED CLIENTS

V. FAMILY MEMBER INTERVIEWED (CHECK ONE):

MOTHER

STEP-MOTHER

FATHER

STEP-FATHER

IDENTIFIED CLIENT

OTHER (SPECIFY) ____________________


QUESTIONNAIRE AND ANSWER SHEET FOR PHONE INTERVTEWS WITHFAMILIES WHO HAVE DROPPED OUT OF TREATMENT

INSTRUCTIONS TO TELEPHONE INTERVIEWER:This form includes a suggested introduction to use when calling the families/ the actual questions to ask the family member you speak with, and space to write down the answers. There will be space to write down verbatim responses as well as checklists to help make recording the answers easier. Both should be used.Whenever possible, the contact person should be the mother or step-mother in the family. This may require call-backs. If this becomes too much of a problem, ask to speak to the father next, and if this is impossible, use the identified client as the contact person.Re-wording or repeating the questions may be necessary so be very familiar with what is requested before attempting to use this questionnaire.The purpose of the interview is to find out why a family dropped out of treatment. The questions will begin with a general information question, followed by more specific questions. Some of the questions may not need to be asked, depending on preceding answers. These questions will be noted. Please be familiar with all questions to avoid duplication and to make the transitions easier.

Important Tips To Remember1. Clearly identify who you are, what you want, and why.2. Clear communication is essential.3. Help the family member feel confortable, not rushed.

Negotiate a better time to call if you catch them at a badtime.

4. Help the family member to feel like what (s)he has to say is of great importance to you.

5.' Always be polite and considerate.


QUESTIONNAIRE FOR PHONE INTERVIEWS WITH DROP-OUTS

Suggested Format For Introduction: (Do not read verbatim)

Hello, may I speak to Mrs. ___________ • My name is ________I am a research‘assistant with the Family Therapy Treatment and

, Training Grant in which you recently participated. Is now a good time to answer some questions? It should not take more than five to ten minutes.(IF THE ANSWER IS "NO", FIND A TIME THAT IS CONVENIENT. DO NOT HANG UP WITHOUT AGREEING ON ANOTHER TIME).

Your name was given to me by the research team because your ■ family stopped coming for treatment. It would be very helpful to the research project to find out why your family decided not to come. Information about your family's experience will help us decide what changes need to be made to make the experience a better one for future families.

I would like to ask you a few questions, but I want to make sure you realize that I am in no way connected with your Court, and any information you give me will never be linked to you by name.

Do you have any questions about who I am or what I need from you?

I


anc Answers:

1. What caused your family to stop coming for family therapy?

Checklist for interviewers only: (Do not read this checklist.Check all blanks mentioned, then double check those blanks indicating more significant problems). a. Transportation problems. b. Conflict with appointment times. c. Unhappy with services. d. Desire by some family members to quit. e. Did not like the therapist. f. Conflict with Probation Counselor. g. Probation was terminated_____ h. Problems got better._____ i. Problems got worse._____ j. Resistance in making changes in the family. k. Moved.

1. Dissatisfied with time required for participation in the grant.

m. Other (Specify): ______________________________________ n.___ o . __________________________________________ _________________

P- _________________________________________________________

- 3 -


2. (Do not ask if not checked in question #1.) Were there any problems keeping the appointments for family therapy?

Yes _____--- No _____

«(If MYes):

Would you please identify what problems you had?:

3. (Do not ask if not checked in question #1.) Was there anything specific about your therapist that influenced your decision to stop treatment?

Yes ______ If yes, could you identify what about yourtherapist you would have liked to be different

No _____ If no, could you identify what about yourtherapist you liked?

4. How could the services have better met your family's needs or problems?


PLEASE NOTE:

Page(s) not included with original material and unavailable from author or university. Filmed as received.

UMI


8. In your opinion, which member(s) of your family most wanted to stop treatment?Checklist.for interviewer (Do not read):

Mother Father Step-Mother

Step-Father Identified Client_____ Sibling Grandparent Other (Relationship __________________ )

Comments:

9. (Do not read - Checklist for Interviewer): Was the decisionto stop treatment unanimous?

Yes _____NO . _____

10. What do you see as the problem or problems that brought your famjly into treatment?

- 6-


Checklist For Interviewer (Do not read): Marital Conflicts Custody Problems Step-Parent Problems Chronic Court Involvement Delinquency School Problems:

academic problems truancy

Financial Problems Alcohol Abuse:

______ with one or both parents with teenager

Drug Abuse: with one or both parents______ with teenager

Sexual Problems:______ with parents______ with teenager

Physical Abuse Other (Please specify)

a. _____________________________b. _____________________________

Now go back over above checklist and put a second check in the blank(s) which represents what seemed to you to be the more significant problem(s) of the family.

11. Do you feel these problems are now (Check one): Better Worse The Same

12. Is there anything else you would like to say about your experience in family therapy?

Thank you very much for helping us with this project.

-7

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission

APPENDIX F

RECIDIVISM INDEX


Please Leave Blank

C N :_____________

FI:

T:

I. INSTRUMENT NAME: RECIDIVISM INDEX

II. ADMINISTRATION DATE: (AFTER TREATMENT,

III. COMPLETED BY: (FULL NAME OF PROBATION OFFICER:

)IV. COMPLETED ABOUT: (FULL NAME OF IDENTIFIED CLIENT:

)


IDENTIFIED CLIENT'S FULL NAME:

G. COURT RECORDS CHECKAttention Probation Counselor: Do not include this as part ofyour interview with the parents, information required on this form must be gathered from the identified client's school records .

1. COURT CONTACTS:Please list all court charges/petitions as noted in the identified client's court file.DATE OFFENSE DISPOSITION COMMENTS

2. If any other children in the family have had court charges/ petitions, please complete the following information:NAME DATE OFFENSE DISPOSITION COMMENTS

3. Comments: Please note any additional comments regarding theabove information.


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APPENDIX G

SATISFACTION WITH TREATMENT QUESTIONNAIRE


Please Leave Blank

C N :_____________

FI: ________

T: ______________

INSTRUMENT NAME: SATISFACTION WITH TREATMENT

II. DATE COMPLETED:

COMPLETED ABOUT: (FULL NAME OF THERAPIST

IV. COMPLETED BY:

FULL NAME:

(CHECK ONE)

FATHER

MOTHER

IDENTIFIED CLIENT

OTHER (PLEASE SPECIFY)


The following questions are concerned with your satisfaction with the quality of the family therapy and services you and your family received from your Family Therapist. Please circle one number for each question. ,

1. How would you rate the services your family received from your family therapist?

POOR AVERAGE EXCELLENT1 2 3 4 5

2. At the end of treatment, do you think the problem that brought you to family counseling is . . .MUCH WORSE THE SAME MUCH BETTER

1 2 3 4 53. How much did your therapist deal with the problem that brought

your family into counseling?NOT AT ALL SOME A GREAT DEAL

1 2 3 4 54. How much do you think the change you see in your family is due

to the family counseling you received?NOT AT ALL SOME A GREAT DEAL

1 2 3 4 55. If you needed help in the future, would you return to this

Family Institute?DEFINITELY MAYBE DEFINITELY

NO YES

If your family had a similar problem in the future, would you want the family therapist's counseling approach to . .CHANGE A CHANGE DO THEGREAT DEAL SOME SAME THING

How many problems do you expect to have in your family within the next year?

m a n y s o me none

1 2 3 4 5


How do you think your family will handle any new problems without outside help or counseling?

POOR AVERAGE • EXCELLENT1 2 3 4 5

On the whole, how satisfied are you with the job done by your therapist?COMPLETELY SOMEWHAT COMPLETELYDISSATISFIED SATISFIED SATISFIED

10. How would you rate your therapist in each of the following areas?:a. The therapist's interest in me depended on the things

I said or did.DEFINITELY DEFINITELYNOT TRUE TRUE

1 2 3 4 5 6b. The therapist nearly always knew exactly what I meant.

DEFINITELY DEFINITELYNOT TRUE TRUE

1 2 3 4 5 6c. The therapist wanted me to be a particular kind of person.


1 2 3 4 5 6d. I felt that the therapist disapproved of me.


The therapist realized what I meant even when I had difficulty in saying it.DEFINITELY DEFINITELYNOT TRUE TRUE

-2


f. The therapist expressed his/her true impressions and feelings to me.

11.

DEFINITELY NOT TRUE

1 2 3 4

I felt appreciated by my therapist.DEFINITELY NOT TRUE

DEFINITELYTRUE

DEFINITELYTRUE

h. The therapist was openly himself or herself in our relationship.DEFINITELY : NOT TRUE

DEFINITELYTRUE

How would you rate the involvement of the following family members in counseling sessions (Rate only those family memberswho live in the home, not live at home).

Check below any family members who do

NOT LIVING AT HOME

NOT AT ALL INVOLVED

SOMEWHATINVOLVED

VERYINVOLV

a. Father:b. Mother:c. Identified Client:d. Brothers and Sisters:e. Other: (Name Who)

2

2

2

2

2

2

2

2

2

2

2

5

5

5

5

5

55

5

5

5

- 3 -


in

12. Were there any other people who were involved in your family counseling? If so, please list by their relationship to you (No names are necessary).

Relationship;

13. Is there anything else that you would like to express about the treatment you received?


68

Satisfaction with Treatment QuestionnaireThe Satisfaction with Treatment Questionnaire is a 17-item

instrument developed by the Family Research Project in order to measure client attitudes about the services received after completion of treatment. The instrument consists of two subscales: (a) Satisfaction with Therapist who provided servicesto the client families, and (b) Satisfaction with Approach and Outcome of treatment. The Satisfaction with Therapist subscale uses a 6-point Likert-type scale in which response categories ranged from a score of 1, or Definitely Not True, to a score of 6, or Definitely True. High scores indicated greater satisfaction with therapist. The Satisfaction with Outcome subscale uses a 5-point Likert-type scale with response categories which range from a score of 1, or Dissatisfaction, to a score of 5, or Total Satisfaction, with a score of 3

, representing Some Satisfaction.The Satisfaction with Treatment Questionnaire was

administered as a posttest measure to Mothers, Fathers, and Identified Clients who completed treatment in the Family Research Project.


APPENDIX H

HUMAN SUBJECTS REVIEW:

INFORMED CONSENT AND

RELEASES OF INFORMATION

W1: FAMILY WRITTEN AND VIDEOTAPE

INFORMED CONSENT

W2: FAMILY RELEASE OF INFORMATION

FAMILY RESEARCH PROJECT


JUVENILE COURT SERVICES UNIT


W1: FAMILY WRITTEN AND VIDEOTAPE

INFORMED CONSENT


FAMILY RESEARCH - INFORMED CONSENT

I understand that by signing this form I agree to take part in a research study about family relations and treatment of adolescents under supervision of the Virginia Department of Correction. I understand that my part' and my family’s part in this study will include answering written questions about our family and ourselves, being videotaped and being interviewed a number of times.

I understand that because some of the information I will be asked about is personal and private, both the information and my identity will be treated as strictly confidential by the researchers. I understand that the information I give about myself and my family is for only research and educational purposes.

My agreement to take part in this study is completely voluntary. I have not been promised anything in return for my participation and I understand that I will not get anything for my participation except a better understanding of myself and my family. I have been given a chance to ask questions about the study and all my questions have been answered to my satisifaction. I understand that I am free to quit taking part in this program at any time.


I agree to take part in this research out of a sincere desire to be of help in increasing the knowledge about families and adolescents and because it is my belief that taking part in this study might benefit myself, other families and adolescents within the juvenile justice system.

Date Signature of Participant


Date Signature of Witness


FAMILY INSTITUTE OF VIRGINIA DEPARTMENT OF CORRECTIONS

JUVENILE AND DOMESTIC RELATIONS COURT FAMILY RESEARCH PROJECT

Reply To:

RELEASE OF INFORMATION

I, ________________________________________ hereby authorize______________________________________of the Family Institute of Virginia,the Department of Corrections and/or the Family Research Project research evaluators to inspect and/or both obtain copies of any and all court, medical, psychological, social history, school or other records or videotapes of whatever kind pertaining to me.

A copy of this same form shall also serve as my authorization to the custodian of any records pertaining to me to release them to the person and agencies named above.

Date: Signed: ______________________________

Witness: ________________________ _____________________________Parent or Guardian of Minor



JUVENILE COURT SERVICES UNIT


DEPARTMENT OF CORRECTIONS FAMILY THERAPY TREATMENT RESEARCH GRANT JUVENILE AND DOMESTIC RELATIONS COURT

Reply to:

RELEASE OF INFORMATION

I , ________________ hereby authorize__________________________ _____ °f Juvenile andDomestic Relations Court and/or the Family Therapy Treatment research evaluators to inspect and/or both obtain copies of any and all court, medical, psychological, social history, school or other records of whatever kind pertaining to me.

A copy of this same form shall also serve as my authorization to the custodian of any records pertaining to me to release them to the person and agencies named above.

Date:__________________ Signed:_________________________Witness:........................ ...

Parent or Guardian of Minor


APPENDIX I


VIDEOTAPE RELEASE FORMS

V1: FAMILY VIDEOTAPE CONSENT FORM

V2: PROCESS CODERSCONFIDENTIALITY AGREEMENT BEAVERS TIMBERLAWN CODERS

V3A.1: THERAPIST VIDEO INFORMED CONSENT (BOWEN)

V3A.2: THERAPIST VIDEO INFORMED CONSENT GEORGETOWN UNIVERSITY (BOWEN)

V3B.1: THERAPIST VIDEO INFORMED CONSENT (HALEY)

V3B.2: THERAPIST VIDEO INFORMED CONSENTFAMILY THERAPY INSTITUTE OF WASHINGTON (HALEY)

V3C.1: THERAPIST VIDEO INFORMED CONSENT AVANTA NETWORK (SATIR)

V4: PROCESS CODERSCONFIDENTIALITY AGREEMENT TYPESCRIPTER AND NONVERBAL CODERS

V5: PROCESS CODERSCONFIDENTIALITY AGREEMENT UNITIZERS AND CODERS


V1: FAMILY VIDEOTAPE CONSENT FORM


FAMILY INSTITUTE OF VIRGINIA VIRGINIA DEPARTMENT OF CORRECTIONS

FAMILY RESEARCH PROJECT INFORMED CONSENT FOR USE OF INFORMATION AND VIDEOTAPES

I h_ve taken part in a research study about family relations and treatment of adolescents under the supervision of the Family Institute of Virginia, and the Virginia Department of Corrections. My part and my family's part in this study included answering written questions about our family and ourselves and being videotaped.I understand that some of the information I have been asked about is personal and private and therefore my name and my family's name will be treated as strictly confidential by the researchers and the Department of Corrections. However, I understand that the information I have given about myself and my family and the videotapes will be used by the researchers and the Department of Corrections for educational and research purposes and that this will entail making the information and the videotapes, but not my family's name, available for use and viewing, research and evaluation to other parties and groups as authorized by either the Family Institute of Virginia or the Virginia Department of Corrections.I understand that the tapes and material related to the tapes may be made available, in whole or in edited form, to mental health, medical and educational institutions; it may also be presented at meetings or gatherings of professional groups. I hereby give my permission for the videotapes to be used for research and educational purposes as specified above.The undersigned hereby releases the Family Institute of Virginia and the Virginia Department of Corrections, and any party acting under their authority or permission, from any and all claims he/she may have against them on account of, or arising out of taking, recording, reproducing, publication, transmitting or exhibiting of the videotapes and related information.My agreement to take part in this study has been completely voluntary.I have not been promised anything in return for my participation. I have been given a chance to ask questions about the study and all my questions have been answered to my satisfaction. I have been free uo stop taking part in this program at any time.I have taken part in this research out of a sincere desire to be of help in increasing the knowledge about families and adolescents and


because it is my belief that taking part in this study might benefit myself and other families and adolescents within the juvenile justice system.



The above consent was read and signed in my presence. In my opinion, the person signing did so fully and with an understanding of its contents and the implications of such contents.

Date Witness


V2: PROCESS CODERSCONFIDENTIALITY AGREEMENTBEAVERS TIMBERLAWN CODERS


CONFIDENTIALITY AGREEMENT FOR FAMILY RESEARCH PROJECT BEAVERS TIMBERLAWN CODERS

I understand that the videotapes that I will be viewing are of families who voluntarily agreed to participate in family therapy sessions as part of the Family Research Project as well as of their rehabilitation program supervised by the Virginia Department of Corrections.I understand further that the information on these videotapes concerns the personal lives and concerns of these families, is privileged information, and therefore is deserving of absolute confidentiality on my part. I agree to treat all this information as confidential, and will not discuss any specific or identifying aspects of this information with any person who is not officially part of the Family Research Project staff.I further agree to view the tapes when alone or in the presence of Family Research Project staff only. Finally, I agree that if, by chance, I happen to recognize or be familiar with any family members on the tapes I view, I will stop immediately any further monitoring of videotapes for that particular family and report the situation to the Project Director.I understand all components of this confidentiality form and voluntarily agree to abide responsibly by these conditions.

Date Signature

The above consent was read and signed in my presence. In my opinion the person signing did so fully and with an understanding of its contents and tbe implications of such contents.



V3A.1: THERAPIST VIDEO INFORMED CONSENT (BOWEN)


APPENDIX III


INFORMED CONSENT

As a therapist participating in the Virginia Family Research Project,I conducted one or more interviews with families referred by the juvenile court system. Many of these interviews were videotaped.I hereby give my permission for all of the videotapes of these interviews to be utilized for research and educational purposes.Part of the research and use may include the publication of portions of written transcripts of these tapes.I understand that the tapes and material related to the tapes may be made available, in whole or in edited form, to mental health, medical and educational institutions, and also it may be presented at meetings or gatherings of professional groups. I hereby consent to such use of the videotapes.The undersigned hereby releases the Family Institute of Virginia, the Virginia Department of Corrections and the Georgetown Family Center, their agents, employees, successors or assigns and any party acting under their authority or permission, from any and all claims he/she may have against them on account of, or arising out of such taking, recording, reproducing, publication, transmitting or exhibiting of the information specified above.

Date Signature of Therapist

The above consent was read and signed in my presence. In my opinion the person signing did so fully and with an understanding of its contents and the implications of such contents.

Date Witness


V3A.2: THERAPIST VIDEO INFORMED CONSENTGEORGETOWN UNIVERSITY(BOWEN)


GEORGETOWN DIVERSITY MEDICAL CENTERWa s h i n g t o n , d .c . 20007

The undersigned hereby consents to the taking of recording of his/her voice, likeness or photograph or motion picture and the production of closed circuit television programs, video tape recordings and other visual and/or auditory recordings by Georgetown University Hospital and anyone acting under the authortiy of said Hospital. I understand that this material may be made available, in whole or in edited form, not only to the staff and residents of Georgetown University Hospital, but also to medical and educational institutions and also that it may be presented at meetings or gatherings of professional groups. I hereby consent to such use.

The undersigned hereby releases Georgetown University Hospital, and any party acting under its authority or permission, from any and all claims he/she may have against them on account of or arising out of such taking, recording, reproducing, publication, transmitting, or exhibiting as authorized by Georgetown University Hospital.


If signing as guardian, committee, or nearest relative of participant:

Signature

Relationship to participant

The aboved consent was read, discussed, and signed in my presence. In my opinion the person signing said consent did so freely and with full knowledge and understanding of its content and the implications of such contents.

Witness: ______ ______________ _ ____Date


V3B.1: THERAPIST VIDEO INFORMED CONSENT (HALEY)


A P P E N D IX I I I


INFORMED CONSENT

As a therapist participating in the Virginia Family Research Project,I conducted one or more interviews with families referred by the juvenile court system. Many of these interviews were videotaped.I hereby give my permission for all of the videotapes of these interviews to be utilized for research and educational purposes.Part of the research and use may include the publication of portions of written transcripts of these tapes.I understand that the tapes and material related to the tapes may be made available, in whole or in edited form, to mental health, medical and educational institutions, and also it may be presented at meetings or gatherings of professional groups. I hereby consent to such use of the videotapes.The undersigned hereby releases the Family Institute of Virginia, the Virginia Department of Corrections and the Family Therapy Institute of Washington, D.C., their agents, employees, successors or assigns and any party acting under their authority or permission, from any and all claims he/she may have against them on account of, or arising out of such taking, recording, reproducing, publication, transmitting or exhibiting of the information specified above.



Date Witness


V3B.2: THERAPIST VIDEO INFORMED CONSENT FAMILY THERAPY INSTITUTE OF WASHINGTON (HALEY)



FAMILY THERAPY INSTITUTE OF WASHINGTON, D. C. INFORMED CONSENT

As a therapist participating in the Virginia Family Research Project,I conducted one or more interviews with families referred by the juvenile court system. Many of these interviews were videotaped.I hereby give my permission for all of the videotapes of these interviews to be utilized for research purposes. Part of the the research and use may include the publication of portions of written transcripts of these tapes. I understand that the tapes will be restricted to viewing by researchers, and there is to be no viewing of the tapes by professional or lay people other than as specified below.I also understand that Mr. Jay Haley, Director, Family Therapy Institute of Washington, D.C., has selected the tapes listed below as suitable viewing for educational purposes, and these tapes may be shown for educational purposes. I understand that the tapes and material related to the tapes may be made available, in whole or in edited form, to mental health, medical and educational institutions, and also it may be presented at meetings or gatherings of professional groups. I hereby consent to such use of the following tapes and related information:Identified Client Name Date of Session

The undersigned hereby releases the Family Institute of Virginia, the Virginia Department of Corrections and The Family Therapy Institute of Washington, D.C., their agents, employees, successors or assigns and any party acting under their authority or permission, from any and all claims he/she may have against them on account of, or arising out of such taking, recording, reproducing, publication, transmitting or exhibiting of the information specified above.I agree to the above out of a sincere desire £o increase the knowledge in the field of family therapy.



___________________ Witness:Date

with permission of the copyright owner. Further reproduction prohibited without permission.

V3C.1: THERAPIST VIDEO INFORMED CONSENT AVANTA NETWORK (SATIR)


APP E N D IX I I I


INFORMED CONSENT

As a therapist participating in the Virginia Family Research Project,I conducted one or more interviews with families referred by the juvenile court system. Many of these interviews were videotaped.I hereby give my permission for all of the videotapes of these interviews to be utilized for research and educational purposes.Part of the research and use may include the publication of portions of written transcripts of these tapes.I understand that the tapes and material related to the tapes may be made available, in whole or in edited form, to mental health, medical and educational institutions, and also it may be presented at meetings or gatherings of professional groups. I hereby consent to such use of the videotapes.The undersigned hereby releases the Family Institute of Virginia, the Virginia Department of Corrections and Virginia Satir and the Avanta Network, their agents, employees, successors or assigns and any party acting under their authority or permission, from any and all claims he/she may have against them on account of, or arising out of such taking, recording, reproducing, publication, transmitting or exhibiting of the information specified above.



Date Witness


V4: PROCESS CODERSCONFIDENTIALITY AGREEMENTTYPESCRIPTER AND NONVERBAL CODERS


A P P E N D IX IV

CONFIDENTIALITY AGREEMENT FOR FAMILY RESEARCH PROJECT

TYPESCRIPTERS & NONVERBAL CODERS

I understand that the videotapes that I will be viewing are of families who voluntarily agreed to participate in family therapy sessions as part of the Family Research Project as well as of their rehabilitatiori program supervised by the Virginia Department of Corrections.I understand further that the information on these typescripts concerns the personal lives and concerns of these families, is privileged information, and therefore is deserving of absolute confidentiality on my part. I agree to treat all this information as confidential, and will not discuss any specific or identifying aspects of this information with any person who is not officially part of the Family Research Project staff.I further agree to wear headphones at all times when viewing these videotapes, and to view the tapes when alone or in the presence of Family Research Project staff only. Finally, I agree that if, by chance, I happen to recognize or be familiar with any family members on the tapes I view, I will stop immediately any further monitoring of videotapes for that particular family and report the situation to the Project Director.I understand all components of this confidentiality form and voluntarily agree to abide responsibly by these conditions.

Date Signature




V5: PROCESS CODERSCONFIDENTIALITY AGREEMENTUNITIZERS AND CODERS


APPEN D IX V

CONFIDENTIALITY AGREEMENT FOR FAMILY RESEARCH PROJECT

UNITIZERS AND CODERS

I understand that the typewritten transcriptions (typescripts) which I will be unitizing or coding are verbatim recordings of samples taken from the therapy sessions of families who voluntarily agreed to participate in family therapy as part of the Family Research Project as well as of their rehabilitation program supervised by the Virginia Department of Corrections.I understand further that the information contained in these typescripts concern the personal lives and concerns of these families, is private information, and therefore, is deserving of absolute confidentiality on my part. I agree to treat all this information as confidential, etc.I also understand that these typescripts are to remain inside the Family Institute of Virginia at 2 910 Monument Avenue and are never to be taken in any form from the building.I agree to work with these typescripts either when alone or in the presence of Family Research Project staff only. Further, I agree that if, by chance, I happen to recognize or be familiar with any family members I may identify from the typescript information, I will stop immediately any further viewing of typescripts for that particular family and report the situation to the Project Director.

Date Signature

The above consent was read and signed in my presence. In my opinion, the person signing did so fully and with an understanding of its contents and the implications of such contents.



APPENDIX J


DOCUMENTATION OF PRIOR APPROVAL

A. VIRGINIA COMMONWEALTH UNIVERSITY

B. NATIONAL INSTITUTE OF MENTAL HEALTH


A. VIRGINIA COMMONWEALTH UNIVERSITY


October 13, 1981

Dr. Donald L. Drummer Chairman, Committee on Conduct of Human Research 1022 East Marshall Street Richmond, Virginia 232S3Subject: Revision of consent forms for "Process and Outcome

Study of Three Family Approaches"Dear Dr. Brummer:Thank you very much for your review and acceptance of our Family Research Project "Hunan Subjects" informed consent.As requested by correspondence dated August 31, 1981, the following changes have been made to the consent forms for the Research Project

1) Paragraph 5 has been deleted from Appendix I and Appendix III.

Attached are three (3) copies of each consent form for each Institute. If you need any additional information, please contact me.

Sincerely,

Joan E . Winter Project Director

JEWsrlhAttachement


f O : 1 VIRGINIA COMMONWEALTH UNIVERSITY

Inter-Office Correspondence

Date: August 31, 1981

To; Ms. Joan E. W in te rs Dr. Donald J. Kieslep

From: Dr. Donald L. Brummer, ChairmanCommittee on the Conduct of Human Research

Subject: Protocol "Process and Outcome Study o f Three Family Approaches."

The above protocol was reviewed and approved by the Committee on the Conduct o f Human Research on August 26, 1981, subject to the fo llow ing s t ip u la t io n s :

1) Delete 5th paragraph o f Appendix I in the consent form. Also de lete 5th paragraph o f Appendix I I I .

Kindly forward 3 copies o f each o f these consent forms to Mrs. Delores Watts, O ff ice o f Research and Graduate Studies, Box 568, MCV Station , upon acceptance o f which an approval notice w i l l be sent to you.

DLB/dw


B. NATIONAL INSTITUTE OF MENTAL HEALTH


4

D E P A R T M E N T OF H EA LTH & H U M A N SERVICES Public Health Serv.ce

Alcohol. Drug Abuse, and- - . Qfl. Mental Health Administration

August 19 , 9o National Institute of Mental HealthRockville MD 20857

Joan E. Winter, MSW BS Co-Di rectorFamily In s t i tu te o f V irg in iaResearch and Educational Services Grant #: 1R01 HH 37030-012910 Monument Avenue Receipt Date: August 15, 1981Richmond, VA 23221

Dear Dr. Winter:

This w i l l acknowledge rece ip t o f the above referenced research grant a p p l ic a t io n .I t has been assigned to the Treatment Development and Assessment Research Review Committee of the National In s t i tu te o f Mental Health. As Executive Secretary o f th a t Committee, I w i l l be arranging fo r the review of your proposal.

Each proposal receives two reviews. The f i r s t review is by a committee o f twelve s c ie n t is ts who evaluate the s c ie n t i f ic and technical merit o f the proposal. The National Advisory Mental Health Council provides the second review and is responsible for policy considerations. By law, no award may be made without a recommendation o f approval by the Council, and recommendations by the i n i t i a l or peer review group are subject to modifications by the Advisory Council. The Council w i l l review your proposal a t i t s meeting te n ta t iv e ly scheduled fo r March 1982. You w i l l be informed o f the Council's f in a l action as soon as possible a f t e r th a t meet ing .

On Ju ly 27, 1981 new procedures perta in ing to the protection o f human subjects went in to e ffec t in the Department o f Health and Human Services. The changes were published in the January 26, 1981 Federal Register. The write-up in the Federal R eg is ter is quite extensive, and the Public Health Service is s t i l l in the process o f developing i t s regulations. The new procedures in e f fe c t now, however, have two important aspects which I want to c a l l to your a tte n t io n . F i r s t , c e r ta in categories for exemptions have been created for proposals which involve human subjects . You should check with your o f f ic e o f sponsored research to see i f your proposal fa l ls under one o f the exemptions. Note however, th a t ANY in v es t ig a to r w ith a proposal involving human subjects , whether or not the proposal meets one o f the exemption c r i t e r i a , MUST s t i l l complete items 1, 2 and 3 o f Form 596, "Protection of Human Subjects A ssu ran ce /C ert if ica tio n /D ec la ra t io n ." The second major change is th a t the Agency, the Alcohol, Drug Abuse and Mental Health Adm in istrat ion , is now enforcing a regulation which has been in existence for a number o f years, but not monitored c a re fu l ly . That is , the 596 Form MUST be received within s ix ty days a f te r rece ip t o f your ap p lica tio n , o r the ap p lica tio n w i l l be adm in is tra tive ly deferred u n t i l the next review cycle. The re c e ip t date fo r your application is indicated above. To avoid a delay in the review o f your a p p l ic a t io n , please be sure th a t a copy o f the Form 596, perta in ing to your a p p lic a t io n is sent to me, i f i t has not already been included in your proposal, w ith in s ix ty days o f the above rece ip t date.


-2-

In a d d it io n , I am requesting th a t you complete the enclosed b r ie f form on the "Protection of Human Subjects" aspects o f your proposed research and re turn i t as soon as possible. Although some o f th is information is already contained in your proposal, i t f a c i l i t a t e s the review process to have a surranary on th is important top ic . A pre-addressed franked envelope is enclosed for your convenience. Any additional m ateria ls you wish to send in support o f your app lica tion should be sent d ire c t ly to me as soon as possible, but no la t e r than October 10, 1931. A ll correspondence should reference the grant number above.

I f you have any questions, do not hes ita te to contact me, e ith e r by telephone (301) 443-6470, or by w r it in g to me a t the National In s t i tu te o f Mental Health, Parklawn Building, Room 4-68 , 5600 Fishers Lane,Rockville , Maryland 20857.

Thank you fo r your in te re s t in the research programs o f the National In s t i tu te o f Mental Health.

S incerely ,

yane F. Carey, Ph.D. J Executive SecretaryPsychosocial and Biobehavioral Treatments

Research Review Subcommittee

Enc.


October 16, 1981

Jane F. Carey, Ph.D.National Institute of Mental HealthParklawn BuildingRoom 4-665600 Fishers LaneRockville, MD 20857Dear Dr. Carey:Thank you for acknowledging the receipt of Grant Application 1 ROl MH 37030-01, and for the detailed explanation of the review process of the proposal.In your letter, you explained the new guidelines to protect the use of the human subjects in research. As requested, we have already submitted Form 596 with the original grant proposal on July 1, 1981. (Copy attached).Also we have received notification of approval from the Committee on tne Conduct of Human Research (G0239) under the auspices of Virginia Commonwealth University in Richmond, Virginia. There were two changes made in the Appendices (Appendix I and III), and the revisions have been submitted to the Committee. I have enclosed copies of the letter and the revisions to be included in the review of the proposal.Enclosed you will also find the completed "Protection of Human Subjects" form as requested. Also enclosed are copies of all appendices.If you have any questions, do not hesitate in calling me.

Sincerely,

O(JJ6an E. Winter Project Director

JEW:rlhEnclosures


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INNome of Pl/PO/P»ogfom Coo«ci''o'o* o* Co^d cce *•»*’

Winter, Joan E.J Soc*0> S e tu 'i'y Nu>»t*v<

! 526-82-0481*

E. Human SubjectsAll human subjects began thfeir participation in the project prior to this request for funding. An "Informed Consent" and "Release of Information" forms were drafted and reviewed by the Virginia Department of Corrections and all Juvenile and Domestic Relations judges referring families into the project. (See Appendix XI).The Department of Corrections stated that the client privacy measures taken in the project "met not only the standard of Virginia's laws on privacy but also the spirit as well."1. Subjects; All client families referred to the project (over

300 families) had a youth who had been before the juvenile court (some clients were on court probation.) They ranged in age from 8-18 and represented all socioeconomic backgrounds and races (Caucasian, Black, Japanese, Hispanic).

2. Recruitment: Professionals from the Juvenile Courts (12) ,Social Services Agencies (5) and Mental Health Clinics referred families they felt needed assistance into the research pool. The only criteria was that a youth had had contact with the juvenile justice system. All participation on the part of the families was voluntary. Upon referral, the Family Research Project staff made contact with the family, discussed their voluntary participation and the fact that the family counseling was a research project intended to helpnot only their family but also to help develop a more effective family counseling program for juvenile offenders. After this point, pre-testing began.

3. Potential Risks: Since all of the families were to be treated by "successful" family therapists, supervised in a close manner, it was felt that the risks were minimal to the families. Of course, there was the stress of family therapy on the family system, however, this stress would be present anytimea family engaged in treatment. See the "Informed Consent" and "Release of Information" for privacy considerations.

4. Safeguards; All video tapes will be kept at the Family Institute of Virginia Research and Educational Services. Type- sc^ipters and a Research Assistant will be the only people to view the therapy videotapes. If, at a later date, an educational use of the tape is desired, for a wider audience, an additional consent form will be secured from the specific family (available upon request). The Beavers-Timberlawn tapes will be view by only 2-4 trained and licensed professional family practitioners.

5. Benefits; The families have had the benefit of "expert" family intervention. Since all three principal treatment groups are motivated to be successful with the families, one can assume that the families will get the "creme de la creme".

6- Risks Versus Benefits - (See above).

•wc


5 . IN V E S T IG A T IO N A L NEW D R U G S -A D O IT IO N A L C E R T IF IC A T IO N R E Q U IR E M E N T

CECTIOK 46.17 O F TITLE 4$ O F THE Code o f Federal Re filiations states. "Where an organization is required to prepare or to submit a cer- '-a t io n . . . and the proposal involves an invesrifanonal new druf within the meaninf o f The Food. Druf. and Cosmetic Act. the druf shall

jentified in the certification tofether with a statement that the 30-day delay required by 21 CFR 130.3tal (2 / hat elapsed and the Food and ... u f Administration has nor. pnor to expiration o f such SOdcv interval, requested that the sponsor continue to withhold or to restrict use o f the drug in human tub/eets. or that the Food and Drug Administration has waived the 30dav delay requirement, provided, however, that in those cases in which the 30-dav delay interval has neither expired nor been waived, a statement shall be forwarded to DHHS upon such expiration or upon receipt o f a waiver. Ho certification shall be considered acceptable until such statement has been received."

IN V E S T IG A T IO N A L NEW D R U G C E R T IF IC A T IO N

T O C E R T IF Y C O M P L IA N C E W IT H F O A R E Q U IR E M E N T S F O R P R O P O S E D U S E O F IN V E S T IG A T IO N A L N E W O R U G S IN A D D IT IO N T O C E R T IF IC A T IO N O F IN S T IT U T IO N A L R E V IE W B O A R D A P P R O V A L . T H E F O L L O W IN G R E P O R T F O R M A T S H O U L D B E U S E D FO R E A C H IN O : (A T T A C H A D O IT IO N A L IN O C E R T IF IC A T IO N S A S N E C E S S A R V ).

— IN O F O R M S F IL E D : ^ 2 F O A 1 5 7 1 . H F D A 1 5 7 2 . C l F O A 1 5 7 3

— N A M E O F IN O A N D S P O N S O R

— D A T E O F 3 0 -O A V E X P IR A T IO N O R F D A W A IV E R

(F U T U R E D A T E R E Q U IR E S F O L L O W U P R E P O R T T O A G E N C Y ) ___________________________________

— F O A R E S T R IC T IO N _______________________________________________________________________________________

— S IG N A T U R E O F IN V E S T IG A T O R __________________________________________________________ D A TE

6 . C O O P E R A T IN G IN S T IT U T IO N S - A D D IT IO N A L R E P O R T IN G R E Q U IR E M E N T

S E C T IO N 4 6 .1 6 O F T IT L E 45 O F T H E C ode o f F e d e ra l R e g u la t io n IM P O S E S S P E C IA L R E Q U IR E M E N T S O N T H E C O N D U C T O F S T U D IE S O R A C T IV I T I E S IN W H IC H T H E G R A N T E E O R P R IM E C O N T R A C T O R O B T A IN S A C C E S S T O A L L O R S O M E O F T H E S U B J E C T S T H R O U G H C O O P E R A T IN G IN S T IT U T IO N S N O T U N O E R IT S C O N T R O L . IN O R D E R T H A T T H E D H H S B E F U L L Y IN F O R M E D . T H E F O L L O W IN G R E P O R T IS R E Q U E S T E D W H E N A P P L IC A B L E .

* . F O L L O W IN G R E P O R T F O R M A T F O R e a c h i n s t i t u t i o n O T H E R T H A N G R A N T E E o r C O N T R A C T IN G IN S T IT U T IO N W IT H P O N S IB IL IT V F O R H U M A N S U B JE C TS P A R T IC IP A T IN G IN T H IS A C T IV IT Y : (A T T A C H A D D IT IO N A L R E P O R T S H E E T S AS

.X S S A R Y ) .

IN S T TTU T IO N A L A U T H O R IZ A T IO N FO R ACCESS TO SUBJECTS

— s u b j e c t s ; s t a t u s (w a r d s , r e s i d e n t s , e m p l o y e e s , p a t i e n t s , e t c .) ScKfc subjects are juveniles referred by the juvenile courts. Sane are on probation, saie are not under the N3lcffi»g -cti°n Qg the court. ...... 6-18N A M E O F O F F IC IA L (P L E A S E P R IN T ) W i l l i a m R - R a d p r _____________________________________________________________________

t i t l e Regional Court Services Manager___________TF, r „ ^ r (703) 591-9400_____n a m e a n d a d d r e s s o f Virginia Department of Corrections___________c o o p e r a t i n g i n s t i t u t i o n 11110 Main Street

Fairfax, Virginia— O F F IC IA L S I G N A T U R E ______________________________________________________________________________________________________

W O TC S; ( tu g ., r e p o r t o f m o d if ic a t io n in p ro p o s a l as s u b m it te d to a ge ncy a f fe c t in g h u m a n su b je c ts in v o lv e m e n t)

Attached is an "Informed Consent" and "Release of Information" signed by the participants in the research study. It has been approved by the Virginia • Department of Corrections, including all Juvenile and Domestic Relations Judges who.referred families to the project. They do not have a DHHS Assurance Number. However, the study is now pending review by the Virginia Commonwealth University Human Subjects Review Board (G0239), which oversees the activities of the Principal Investigator and other researchers; Our i ■'ject is now pending review of this board on August 26, 1981. The Family 1 titute of Virginia, Research and Educational Services (Nonprofit) does not nave a DHHS review board, however, if deemed necessary it will submit DHHS documentation as required.

H H S -S S 6 ( » . . S -6 0 ) (B tc k )


D E P X R T M E M O F H E A L T H & H L M A N S E R V I C E S P u D l i c H e a i t h S e r v . e e

c a r — Alcohol. Orug Abuse, andMental Health Administration

National Institute of Mental Health Rockville MO 20857

TE fi HH3 7 0 3 0 -0 1W IN T E R , JOAN £

i ^ t i t u t e o f v i r g th ta 2910 MONJMENT AVENUE RICHMOND, VA 23221

Dear Applicant:

The review of your application for grant support from the National In s titu te of Mental Health has now been completed.

The enclosed Summary Statement contains the In i t ia l Review Group's recommendation along with detailed Information on the s c ie n t i f ic / technical review of your application by the In i t ia l Review Group to which 1t was assigned. At Its most recent meeting, the National Advisory Mental Health Council concurred with their recommendation.

The following general Information w il l help you understand details of the review process and the status of your application.

Most recommendations of In i t ia l Review Groups are unanimous. When they are not, the actual vote 1s Indicated on the Summary Statement. When two or more members d i f fe r from the majority, the Advisory Council gives special attention to the application.

For approved applications, the Sumnary Statement indicates the years and amounts recommended for support and reflects the priority score assigned to the application by the In i t i a l Review Group.

I t is Important to understand that because of limited funds, approval of an application does not assure that funding w ill be available. I f funding 1s available, there 1s no assurance that the application w il l be funded at the recommended level.

Information about the assignment of p r io r ity scores and the ir In te r pretation 1s contained 1n the enclosed sheet entitled "ADAMHA P rio rity Scores." Because the distribution of p rio r ity scores may vary from committee to committee, p r io r ity scores for applications reviewed by d iffe re n t committees may not be s t r ic t ly comparable. Such variations are monitored by s ta ff and are taken Into account when funding decisions are made.


Applicant

Disapproval of an application by the Council 1n no way precludes consideration of any requests for support you may make 1n the future. I f you wish to submit an application in the future, we w ill give 1t our fu l l consideration.

I f you need further information on your application, you should contact the s ta ff person responsible for the program to which your application was assigned. The program class code (which appears as a 2 or 3 le t te r code on the upper right corner of your Summary Statement below the grant number) indicates the Individual on the enclosed 11st of Ins titu te S taff whom you should contact for this purpose.

Sincerely yours,

Bruce t . RlnglerBruce t . Rlngler ChiefGrants Management Branch

3 Enclosures


\r rm ie g e u ^uim nuiM M uw i>i

*«CHIC4t*OA N « n N T : 1 SO I 3 H 3 7 0 3 0 -0 1OmII .

w » m . N ISH PSTCHOSOC C B I03EH A 7 TBEATHT S0BC03 TR-Ammmiow i OCT«/SOTa 1987

ia**ama<«i B lVTEBf J O I I 2 Oa*fM< H S3 BSCO-DIRECTOR

» « « « • . PARTLY 1 X 5 7 1 7 0 7 2 0 ? V IR G IN IA C lty .S U M i BICHHOND, 7A I m u m im S tan Oats: 0 5 /0 1 /8 2

P a . K t T . m t PROCESS A9S OOTCOHE STODT 0? THREE P A U L Y APPROACHES

DISAPPR07AL (UNANIMOUS) prtomy Scot*

HUHA5 SUBJECTS - PROTECTION ADECOATE

0102a«COMMCMO«0

a«AMT»«ft<O03 3 0 ,4 5 11 4 3 ,0 9 0

RESUME; Funds are requested Co analyze empirically behaviors of cherapiscs (process) and families (outcome) who participated in a research project which was designed to compare three family therapy procedures with a sample of families with delinquent adolescents. The objectives of this project have merit. However, as this application is written, lc does not provide sufficient information about the methodology involved when che data were > collected and che conceptual bases of che three therapies utilized; the methodology involved in obtaining che process data needs to be elucidated; data analyses are not specified; and the budget is exorbitant. It was felt that che applicant needs to determine whether or not che outcome data from the three therapies are significantly different before beginning che process analyses. Therefore, disapproval was unanimously recommended. The applicant should be encouraged to resubmit.HUMAN SUBJECTS: This study will involve videocapces of persons whowere involved in an earlier project. Subjects will give their consent for the capes to be used for research purposes. The staff persons who will be working with this information (cypascrlpters, coders, uniclzers) will have to sign a statement agreeing to maintain che confidentiality of che participants. The committee fait that the human subject procedures are adequate.DESCRIPTION: In .1981, Che sponsoring organization received funds from cheLaw Enforcement Assistance''Administration (LEAA), through che Virginia Department of Corrections, to study the effectiveness of three different family therapy models in treating adolescent delinquents and their families.FINAL ACTION: MARCH 1-3, 1982


WINTER, Joan E. -2- 1 R01 MH37030-0I

The therapists who were involved in this project were trained, selected, and supervised by key proponents or originators of each model: Murray Bowen forche Systems Model, Jay Haley for che Strategic Model, and Virginia Satir for che Communication Model.

In the conducted study, 60 families with juveniles in contact with the lav were assigned to each of che three family therapy groups and a control group (received usual court services). A large number of measures were taken before, during, and within one month and again six months after treatment.The measures represented the dimensions or constructs most important to each model; and clients, individual family members, marital pairs, the family as a whole, and che therapists were assessed. In addition to a number of self-report measures and several therapist racings, school reports and direct observation were included among che outcome measures. While Che major objective data collection and treatment phases have been completed, the data have not been analyzed. However, the analyses will focus on the input or predictor and outcome data.

In the proposed project, funds are requested to analyze the process data that will be taken from samples of interview segments and coded from transcripts of videotapes and to obtain outcome data that focus on the observed functioning and competence of each family from videotapes of che . family in a structured cask session.

The goals of the process analyses are: (1) to obtain a reliable representationof actual therapist behavior in order to compare each model's therapists against the behaviors prescribed by the model and the training (Were therapists working correctly?) against che therapists of other models (How much do che models differ in practice?), and to develop empirically derived profiles of che work of therapists from each model with composites of therapist Interventions compiled for training purposes; (2) to sample che changes in family members' behavior; and (3) to develop a pool of videotapes to be pvailable for other process researchers.

A multi-stage coding approach will be utilized with the process data. The first stage of measurement involves coding according to che intervention categories of the Family Therapist Intervention Coding System (FTICS) which was developed by the project staff and Is sufficiently comprehensive to characterize the interventions of therapists using all three family therapy models, as vail as the five dimenai^wjpf ^insof's (1980) Family Therapist Coding System (TTCS)./' £ secdnd^stage'iof 'measurement will Involve coding therapist's statements at a higher level of abstraction for such constructs as activity level, flexibility, non-verbal, confrontiveness, etc. This system has not been finalized.

Samples will be drawn from che first, second, and third "thirds" of each family's total therapy sessions for each of the three family therapy approaches for a total of 600 videotapes, from which two 10-minute segments will be samples and are assumed to be representative of the entire session. The pre-unitized typescripts taken directly from videotapes of sessions will


WINTER, Joan E. - 3 - 1 R01 MH37030-01

serve as che data format for coding. All verbal plus targeted non-verbal behavior will be included. Graduate or advanced undergraduate students will serve as coders and will be blind as to the particular family therapy approach and for temporal location of each segment.

Outcome data will be obtained by having experienced, graduate trained family clinicians view and rate pre- and post-therapy videotapes of families responding to three structured tasks which successively ask Che family to identify their strengths, identify what they want to change about their family, and to plan something together. The fifteen item Beavers-Timberlawn Family Evaluation Scales will be utilized for this rating. It is hoped that these measures will provide a more naturalistic and functional outcome criteria by which to compare the three models and to identify, for each model, areas of change and no-change. Other outcome measures, from therapist and family members, will be compared with the ratings given by the tape observers. And, finally, it is hoped that the therapist process data can be matched with family interactional process measure to identify those interventions that seem most useful.

CRITIQUE: The overall project, of which this proposal is a part, is very broad and ambitious. This proposal and supporting documents indicate chat the project has attempted to examine issues related to therapist training in addition to examining how different modalities, therapist attributes, and patient attributes contribute to outcome. The goal of attempting to empirically differentiate among family therapy approaches at the process and outcome levels is, indeed, interesting and ambitious enough in its own right. The field of family therapy is in need of solid outcome research as well as clarification of the kinds of changes in functioning and/or structure chat distressed families make when successfully treated, and how those changes are best facilitated by therapist interventions. Thereby, the objectives of the proposed project have merit.

The present outcome study has in a sense been completed with che applicant having made compromises along che way, e.g., in che interests of naturalism, the duration and family membership involved varied; compromises in random assignment were made; etc. The process data herein proposed would in part serve the role of external checks that therapists were conforming to their prescribed techniques— a frequent control device in outcome studies.

As this application is written, however, it does not provide information about several of the methodological procedures that were followed when the data were collected. For example, it seems as if training manuals were not used when the therapists were trained in one of the three proposed therapeutic family approaches. Rather, the developer of each model provided the training, and it seems as if this person also established the initial standards for therapists. Therefore, it is not clear what norms will be used to evaluate within and between model differences in the Family Therapist Intervention Coding System categories. If all Satir therapists, for example, often make pre-supposition


WINTER, Joan E. - 4 - 1 R01 MH37030-01

questions, what does Chat say abcut their adherence to che model? The meaning of the data may be unclear if all therapists of all models equally often make pre-supposition questions. Furthermore, a conceptual basis for expecting these models to be efficacious with juvenile offenders and their families is never discussed in this proposal.

In terms of che sample, it is not clear why the proposed number of families are needed to address che major objectives of this application. Also, che families chat received treatment in the program came into contact with the researchers through the correctional system because each had an adolescent who was in trouble with the law. There is no discussion of this method of selecting research subjects or the meaning of their informed consent or participation under these circumstances. Also, there is no discussion of the kinds of services the control group received and thus for what it controlled. Detailed information was noc provided as to the length of treatment for the various groups, the size of the families, composition (e.g., extended families, single parent), psychopathology of individual family members, etc. In short, the pre-treatment status of the families is unclear, and they may have differed on a number of unspecified dimensions that may have had an important bearing on the conduct of the treatment as well as the outcome.

For che process analyses of therapists' behavior, 1200 ten-minute pre-unitized typescripts will be coded. Several concerns were raised about the proposed procedures. (1) No specific hypotheses are stated concerning differences between the approaches. (2) It is implied chat therapist activity within each system is stable through therapy; yet, it is noc clear what criteria will be used to determine whether a given therapist is "faithful to his or her particular therapeutic approach, what derivations will be tolerated, nor how derivations will be explained. (3) It is not clear why typescripts are being used since much useful information will be lost in the transcrlpcion process. (4) The rationale for summing or combining different kinds of therapist activity is noc stated. What indices will be used? What is their meaning? (S) It does noc seem as if any attention was or will be paid to the possible influence the families will have on the therapists' activity regardless of the therapeutic approach used. (Dr. Kiesler, the principal investigator, was among the first to call attention to the myth of patient, therapist, and treatment uniformity.) (6) More information is needed as to how precisely are the different process dimensions expected to relate to the diverse outcome measures. (7) The applicant has not finalized her chinking as to the criteria for selecting the raters, how and to what level of proficiency the coders will be trained. Further, the coding system proposed has many sub-categories which need some defense in cost/benefit terms (often, more gross measures are more reliable and equally discriminative) and some pilot evidence (that successful and unsuccessful cases may have a chance to show process differences) before beginning such an enormous task. (8) And, f nally, since one of the goals of the FTICS is to be able to differentiate between the three approaches, it would have been helpful if information had been provided as to wnetner or not che developers of che three approaches and their colleagues think that various patterns on the scale do indeed differentiate their techniques. This concern was raised because, although che investigators


WINTER, Joan E. -5- 1 R01 MH37030-01

state chat Bowen, Haley, and Satir were involved in training che therapist, there is na indication that they or their collaborators were involved in the sca-le construction.

With respect to the family interaction outcome measures, che ratings are far more economical to make, the investigators have had some experience with training raters and'with reliability estimates for these scales, and there are studies that suggest the reliability of the Beavers-Timberlawn Scales.It needs to be demonstrated, however, that a family's performance under che proposed conditions correspond to its interaction in real life.

Experienced trained clinicians will serve as raters for the outcome data.The reliabilities for such ratings in a pilot study of 12 families ranged from .17 to .73 on individual scales, which is not convincing even though the coefficient for the sum of the scales was .82 (fl»36 families). However, if experienced persons could be trained up to adequate reliability levels and kept blind for pre- versus post-treatment samples, then these more functional interactional data would usefully complement the many other measures taken.

Throughout this application, there is very limited discussion of how che data will be analyzed. The analytic procedures that will be employed to analyze each data sec need to be specified and justified.

In summary, the committee's feeling was that the applicant has accumulated an extremely valuable set of data which offers important opportunities for understanding the relationship between process and outcome variables in specific schools of family therapy. However, the committee believes that the process analysis should first be justified and then focused by the results of the outcome analysis. That is, the process analysis may noc even be worthwhile, if the outcome analyses fail to reveal any significant treatment effects with any particular type of family. If the principal investigator's outcome analysis reveals such specific effects, then the results of that analysis can be used to focus the process analysis on particular cases. This will reduce the overwhelming task and attendant costs involved in an overall process data analysis.

Additionally, the process analysis should be based on specific profile hypotheses about how the treatments should differ according to theory. Ideally, these hypotheses should be framed or operationalized in terms of the variables or instruments that will be applied to the raw data.

The profile hypotheses could focus the process analysis theoretically, whereas the outcome analysis could focus it empirically. Both can be used to delineate specific process-outcome hypotheses that would be essential in any future research endeavors.

After attention has been paid to the preceding concerns, the committee expressed a desire that the applicant submit a revised application.


R, Joan E. -6- 1 R01 MH37030-01

T: The budget seems excessive for what is proposed with the greateron of it targeted for personnel costs related to coding activities, os several of these positions could be deleted by reducing the number milies that will be included in the analyses, working from the video- rather than typescripts, etc.

chat the tapes presumably have already been made, the request to ise more recording equipment is not justified.

.se, more specification is needed as to the tasks that will be performed

.s project by che consultants— It. Bowen, J. Haley, and V. Satir.

~KEL; Ms . Winter, the 80 percenc time "project director," hasa 1977 M.S.W. irginia Commonwealth University. She was the director of che c from which the data to be analyzed in the proposed research will be Her vita does not indicate publications in psychotherapy research.

Kiesler, the 30 percent time "principal investigator," has a 1967 Ph.D. lical psychology from che University of Illinois. Currently he is a sor at the Virginia Commonwealth University. He has several publications :e relevant to the proposed endeavor; they include papers on design and :menc in psychotherapy research. Dr. Kiesler is well-known in the psychofield; however, his work has not been specifically in the family

• area.

NDATION: The committee unanimously recommended disapproval. Ited a desire that the applicant resubmit after the noted concerns en addressed.


NAMCWINTER

GRANT APPLICATION #:1ROl MH 37030-01

P R 0 T E C T I O N 0 F H U M A N S U B J E C T S(Applicable to primary and secondary sources of data)

1. Subject DescriptionWhat w i l l be the demographic and other defining character is t ics of the subjects, special se t t ings , i f any, (e .g .h o s p i ta ls , schools), sample s iz e , and other relevant descriptors?

2. Subject ConsentWhat w i l l subjects be to ld about the nature o f the study; how w i l l consent be obtained; w i l l i t be wr i t ten or o r a l ; what records w i l l be kept o f consent; what incentives w i l l be provided for p a r t ic ip a t io n , i f any? PLEASE ENCLOSE A COPY OF THE CONSENT FORM(S) IF NOT ALREADY SENT.

3. Data Conf ident ia l i tyWhat precautions w i l l be taken to safeguard id e n t i f i a b le records ofindiv iduals; what procedures w i l l be used for coding and storing data;what w i l l be the immediate and long range uses of the data, thea v a i l a b i l i t y of data to anyone other than project s t a f f , and thecircumstances of such a v a i l a b i l i t y ?


APPENDIX K


APPROVAL

COLLEGE OF WILLIAM AND MARY


Proposal for Research with Human Subjects

Name: JOAN E. WINTER

Department :m COUNSELING

S tatus: DOCTORAL STUDENT

If student, faculty advisor_ CHARLES MATTHEWS,Ph.D.

In a 2 to 3 page precis, provide a general description of the research project, notLng (a) the research question, (b) che scientific or educational benefits of the work, (c) the potential risks to the participants, (d) che investigator responsible (must be a faculty member), and (e) a clear statement of che research methodology.

2. Provide copies of (a) all standardized tests to be used, (b) any questionnaires to be administered, (c) any interview questions to be asked.

3. Provide copies of consent forms (one form for each different class ofsubjects). If the subject is a minor (under 18), parental permission must be obtained in writing. The consent form should contain (a) the researcher's name, (b) the title of the project, (c) a statement abouc whether or noc the results will be anonymous (and if not, what will be done to protect che subject's confidentiality), (d) a brief description of what the subject will be asked to do, with this statement indicating in a general fashion what risks are employed. If Che consent is obtained after che daca have been collected, it must Include a release for che researcher to include the data in any subsequent analysis. If no consent form is possible, the general description above (1) must include a Justification for che procedure.

4. Describe che intended participants, che procedures chat will be used to recruit chose subjects, any payments for participation that will be provided, and an indication of whether the results will be made available Co interested subjects (and a description of liow that will be accomplished).

5. Will the subjects be: (check one)a L _yes no (a) fully Informed. yes no (b) partially informed. yes no (c) deceived.

6. Will subjects be told chat they may terminate participation at any time? X yes noWill subjects be informed that they may refuse to respond to particular questions or refuse to participate in particular aspects of the research? X yes no


7. Does the research involve any physically intrusive procedures orpose a threat to the subjects' physical health in any vay? If so, please explain. hJ o

8. Vill the research involve:physical stress or tissue damage? likelihood of psychological stress (anxiety, electric shock, failure, etc.)? deception about purposes of research (but noc about risks involved)? invasion of privacy from potentially sensitive or personal questions?

If any of the above is involved, explain the precaution to be taken. Also, if any of the above is involved and the research is conducted by a student, explain how the faculty advisor will supervise the project.

9. If any deception is involved, explain the debriefing procedure to be followed.

PLEASE NOTE THAT PROPOSED RESEARCH WILL BE DERIVED FROM ARCHIVAL DATA ONLY. IN ADDITION, THIS RESEARCH ALREADY OBTAINED HUMAN SUBJECTS REVIEW APPROVAL.(SEE ATTACHED DOCUMENTATION)

res (a)res a no (b)

res no <c)es . X.no <d)


HUMAN SUBJECTS REVIEW REQUEST

SELECTED FAMILY THERAPY OUTCOMES WITH BOWEN, HALEY, AND SATIR

THE RESEARCH QUESTION:

The purpose of the study is to investigate three distinct, and weil-known models of family therapy. Specifically, the question to be investigated concerns what family therapy approaches achieve what types of engagement, dropout, completion, recidivism, satisfaction with treatment, locus of control and family functioning outcomes with what kinds of delinquent families. Further, what effect do traditional court services, with no family intervention, have on a similar sample of delinquent families.

SAMPLE

The archival data to be utilized in the proposed investigation were derived from the large-scale Family Research Project (FRP) developed and conducted by the Family Institute of Virginia, under the auspices of the Virginia Department of Corrections. The data is owned by and housed at the Family Institute of Virginia, in Richmond. This study was designed to evaluate the effectiveness of family therapy with youths from the Virginia juvenile justice system and their families (n =249). All families who participated in the project were volunteers.Treatment was provided by therapists (n =48) who were selected, and supervised or trained by three exemplars in the field of family therapy, including Murray Bowen, Jay Haley, and Virginia Satir. Those subjects in the control group received traditional court services under the direction of the Virginia Department of Corrections Juvenile Court Services Units.

RESEARCH METHODOLOGY

A non-equivalent, quasi-experimental design with pre and post treated (n = 188) and comparison (n =61) groups is proposed. The causal-comparative designed in planned to involve three distinct family treatment models and one comparison group.Independent variable included the treatment interventions (Bowen, Haley. Satir, and Comparison group). The dependent variables include 7 criterion variables of clinical engagement, completion, dropout, recidivism, satisfaction with treatment, locus of control and family functioning.Data will be anlyyzed by way of Chi Square, ANOVA and MANOVA statistical procedures. Results of the study will be reported in a manner in compliance with ethical and professional standards of psychotherapy outcome research.

BENEFITS OF THE STUDY:Specifically, the capability of family treatment to keep children out of institutions and jails by working with their family systems was the fundamental aim of this research effort. Treated families benefited by having well trained or supervised therapists


providing psychotherapy. Comparison and treated groups families alike benefited by undergoing the pre and posttesting process, which in and of itself was considered to have an educational effect.With regard to the field of psychotherapy, there exists a "major research priority" is to evaluate "family treatment methods that already have had widespread clinical and training impact" (Gurman & Kniskern, 1981b, p. 756). While family therapy has attained significant positive outcomes, there remains substantial variation between methods of treatment and training. These distinctions result in considerable differences with regard to implementation. As Gurman and Kniskern (1981b) observed: "treatments that have been studied have almost never followed ’pure’ applications of given treatment models" (p.. 745). The proposed study represents the first, and only investigation in family therapy outcome research to utilize exemplars of three well-known and distinct treatment models. Additionally, each pioneer was able to personally direct the particular manner of treatment implementation. Two of these exemplars are now dead. Thus, the analysis of this data represents an unprecedented opportunity to contribute to the field of family therapy.

INSTRUMENTS

Seven instruments will be analyzed in the proposed research (see Appendices A-H). The proposed measures include:1. Client Information Form

This measure was designed by the FRP researchers to gather descriptive data on the treated and comparison group families (30 minutes).2. Rotter Internal-External Locus of Control Scale

This self-report instrument is designed to assess individual differences regarding beliefs about the nature of the world (10 minutes).3. Family Adaptability and Cohesion Evaluation Scales

This self-report instrument is designed to measure the perceptions of family members regarding the family (15 minutes).4. Client Progression Log

This log was developed to identify those families who engaged, dropped, completed, or recidivated in the research study (completed by FRP staff).5 .. Dropout Telephone Questionnaire

A 12 question structured interview was developed in order to collect both quantitative and qualitative information about those families who dropped out of treatment. This measure will be used to explore selective follow-up questions only (15 to 20 minutes).6. Recidivism Index

The prior utilization of court records to collect information regarding further legal charges regarding identified clients and their siblings (FRP staff collected).7. Satisfaction with Treatment Questionnaire

A self-report instrument designed to measure client attitudes about the treatment services and therapist skills after completion of treatment (10 minutes).

POTENTIAL RISKS TO THE PARTICIPANTS

The potential risks to families is minimal. All subjects in the original study were volunteers and free to cease participation at any time. While families were referred by the juvenile court system, only those families who indicated their willingness to be involved in the research project were included in the study. At the point of referral,

with permission of the copyright owner. Further reproduction prohibited without permission

prior to any testing or data gathering, each parent or guardian signed a "Release of Information," and an "Informed Consent" to participate in the research. There were no "deceptions" of subjects in the investigation. Confidentiality of subjects has been strictly maintained (see Appendix I). Each family and therapist were assigned a code number which was maintained throughout data entry and analysis.

INFORMED CO NSENT FORM

Copies of the "Informed Consent" and "Release of Information" forms are attached (see Appendix H). These consent forms were reviewed and approved by the Virginia Department of Corrections, and the Virginia Office of the Attorney General.In addition, at a later stage in the project when applying for additional grant funding to evaluate process data (not part of the present request), the Human Subjects Review Committees of Virginia Commonwealth University, and the National Institute of Mental Health also approved the human subjects procedures involved in the overall Family Research Project. These separate reviews included the human subject research procedures and consent forms contained in the propose research (see Appendix J).

INVESTIGATOR RESPONSIBLE

Dr. Charles Mathews ProfessorSchool of Education College of William and Mary (804) 221-2340Licensed Professional Counselor

DOCTORAL STUDENT

Joan E. Winter2910 Monument AvenueRichmond, Virginal, 23221 -1404(804)355-6876Licensed Clinical Social Worker Board of Behavioral Sciences,

Approved Supervisor,American Association of Marriage and Family Therapy,

Approved Supervisor

Gurman, A. S. & Kniskern. D. P. (1981b). Family therapoutcome research: Knowns and unknowns. In A. S. Gurman and D. P. Kniskern (Eds.), Handbook of family therapy. New York: Brunner Mazel.


APPENDIX L

FAMILY ADAPTABILITY AND COHESION EVALUATION SCALES

DIRECTION OF PRE AND POST MEAN SCORES


FAMILY ADAPTABILITY AND COHESION EVALUATION SCALES

There were three subscales for FACES, including Adaptability, Cohesion,

and Social Desirability. The following subsections briefly summarize the results

of the data analysis.

Adaptability Subscale

Scores on the Adaptability subscale range from 126 to 294; healthy

scores range from 183 to 238. There were no statistically significant findings on

the Adaptability subscale for Mothers, Fathers, or Identified Clients. The

following subsections present the direction and mean score results for the

Adaptability subscale.

Mothers in all three treated groups scored with less Adaptability at the

conclusion of treatment, with the Haley and Satir Mothers scoring below the

healthy range. In contrast, the comparison group Mothers were within the

healthy range for family Adaptability. Parallel with this result, however, is the fact

that the comparison group Mothers had higher pretest Adaptability mean

subscale scores than those in the treated groups. However the comparison

group Mothers’ scores decreased at the posttest. Figure 5.6 provides a visual

representation of the Mothers' Adaptability Subscale pre and posttest means.

Fathers’ mean scores indicated less Adaptability at the conclusion of

treatment for two of the treated groups (Bowen and Haley), as well as in the

comparison group. The posttest m ean score for the three treated groups is

slightly above the healthy range, and below for the comparison group. Among

the four experimental groups only the Satir Fathers' scores increased slightly697


698

from pre to post, remaining within the healthy range for family Adaptability. In

contrast with the Mothers’ Adaptability subscale scores, Fathers had lower mean

scores in the comparison group at both the pre and posttest stage than the pre

and posttest mean score for Fathers in the treated groups. Figure 5.7 provides a

visual representation of the Fathers’ Adaptability Subscale pre and posttest

means.

With regard to the Identified Clients, all three treated groups of Identified

Clients' mean scores indicated a move toward less Adaptability at the conclusion

of treatment. However, the posttest mean score for the treated groups was still

within the healthy range. In contrast, the comparison group Identified Clients

had the highest pre (196.43) and posttest (195.66) mean scores among all the

family members completing the FACES Adaptability subscale. Their score

decreased slightly at the time of posttesting, yet remained within the healthy

range. Further, the nontreated comparison group Identified Clients had greater

pre and posttest Adaptability scores than clients in any of the three treated

groups. Figure 5.8 provides a visual representation of the Identified Clients'

Adaptability Subscale pre and posttest means.

Cohesion Subscale

Scores on the Cohesion subscale range from 162 to 378; healthy scores

range from 235 to 306. There were no statistically significant findings on the

Cohesion subscale for Mothers or Fathers. With the Identified Clients there was

a significant Group effect. The following subsections present the direction and

mean score results for the Cohesion subscale.


699

Mothers, in ail three treated groups, scored with less family Cohesion at

the conclusion of treatment. Nevertheless, the posttest mean score of the

treated groups remained within the healthy range. In contrast, the comparison

group Mothers slightly increased their score at the time of posttesting and were

within the healthy range. Further, Mothers in the comparison group had higher

Cohesion pretest scores, as well as higher posttest scores. Figure 5.9 provides

a visual representation of the Mothers' Cohesion Subscale pre and posttest

means.

Fathers scored with less Cohesion at the conclusion of treatment in two of

the treated groups (Bowen and Haley), as well as in the comparison group.

However, the posttest mean scores remained within the healthy range for all four

of the experimental groups. Only the Satir Fathers scores increased from pre to

post. Similar to the Mothers' Cohesion mean scores, Fathers in the comparison

group had higher pretest scores. Figure 5.10 provides a visual representation of

the Fathers’ Cohesion Subscale pre and posttest means.

Identified Clients scored with greater Cohesion at the conclusion of

treatment for two of the treated groups (Haley and Satir). Both of these

treatment models included Identified Clients in the therapeutic process.

On the other hand, the Bowen group and the comparison group posttest mean

scores decreased at the point of posttesting. Identified Clients did not obtain

therapy with their parents in either of these two experimental groups.

Nonetheless, the posttest mean scores were within the healthy range for the

three treated groups, and for the comparison group.

Identified Clients in the comparison group had substantially higher

Cohesion pretest scores, and correspondingly higher posttest scores than those


700

in the treated groups. This parallels the Mothers' and Fathers' pretest mean

scores, but the Identified Clients' pretest scores were even higher. However, as

reported, there was the highest decrease between pre and posttest scores

among the comparison group clients. Figure 5.11 provides a visual

representation of the Identified Clients' Cohesion Subscale pre and posttest

means.

In effect, the results indicate that the Identified Clients in the comparison

group pretest sample scored with a higher mean level of Cohesion, while those

in the treated samples revealed a lower level of family Cohesion at the time of

the pretest. As indicated by the test developers, the healthy range for Cohesion

scores on FACES is between 235-306. By this standard, only the Bowen

sample, at the pretest stage, scored below this level, while the other three

experimental groups were within the range of healthy scores. However, the

comparison group had the highest mean score on family Cohesion at the pretest

stage (265.48). This finding also indicates that those families referred to the

comparison group initially viewed themselves as more cohesive than those

families who were referred to the treatment groups.

At the posttest stage, Identified Clients in the comparison group sample

scored with a higher mean level of Cohesion, whereas those in the three treated

samples obtained lower mean posttest scores on this subscale. However, this

score represents a decrease in family Cohesion for the comparison group at the

posttest stage, while the direction of mean scores increased for those in the

treated groups from the pre to posttest stage.

The results also revealed that only the Identified Clients in the Bowen

sample decreased their level of family Cohesion between the pre and posttest.


701

The healthy range for Cohesion scores on FACES begins at 235. The Identified

Clients in Bowen group, at the posttest stage, obtained a mean score of 231.30,

a decrease of 2.22 in pre and posttest means. Identified Clients in the Bowen

group were rarely, if ever included in the treatment process. In addition, Bowen

Theory actively eschews the process of increasing family members’ level of

emotional bonding, a component of family Cohesion. Bowen postulated that the

force toward togetherness in families is so indigenous to systems that the

practitioner need not attend to increasing a family system’s level of closeness

(Winter, 1992). Therefore, there would not be a focus on increasing emotional

bonds between family members in this treatment approach. Thus, the decrease

in Identified Clients’ level of Cohesion is congruent with Bowen Theory, as well

as practice.

In sum, Identified Clients in the comparison group were different with

regard to Cohesion from all three of the treated groups at the point of the pretest.

Further, the direction of mean score changes, pre and post, indicated that there

were increases in Cohesion scores among the Haley and Satir families, and

decreases in the Bowen and comparison group at the point of posttesting

(see Figure 5.11).

Social Desirability Subscale

As reported, scores equal to or greater than 34.1 (standardized clinical

mean) indicate higher levels of Social Desirability. Scores above 40 reveal a

false positive, idealized view of the family system on this self report measure.

There were statistically significant findings on the Social Desirability subscale for


702

Mothers, Fathers, and Identified Clients. The following subsections present the

direction and mean score results for the Social Desirability subscale.

The direction of Mothers' scores was higher at the conclusion of treatment

in all three of the treated groups. On the other hand, the comparison group

scores decreased slightly at the point of posttesting. The pre and posttest mean

scores were within the positive regard range for the three treated groups, as well

as for the comparison group. Once again, Mothers in the comparison group had

higher Social Desirability pretest scores than in the treated groups. However, as

reported, there was the greatest decrease between pre and posttest scores

among the comparison group. Thus, the mean score data indicated that the

direction of change for all the treated Mothers increased, whereas Mothers in the

nontreatment, comparison group decreased their perceived level of Social

Desirability. Figure 5.12 provides a visual representation of the Mothers' Social

Desirability Subscale pre and posttest means.

With regard to the Fathers' Social Desirability subscale results, the

comparison group had substantially higher pretest scores which were maintained

at the posttest. The Fathers pre and posttest scores exceeded 40. As reported,

scores equal to or greater than 34.1 (standardized clinical mean) indicate higher

levels of Social Desirability. Scores above 40 reveal a false positive view of the

family system on this self report measure.

The Fathers' mean scores revealed higher level of Social Desirability at

the conclusion of treatment in two (Bowen and Satir) of the treated groups. On

the other hand, the Haley and comparison group scores decreased slightly at the

time of posttesting. The pre and posttest mean scores were within the range of

positive regard for the three treated groups. However, comparison group pre


703

and posttest scores for the Fathers, each above 40, revealed an idealized,

overly inflated picture of the family. Fathers in the comparison group had higher

Social Desirability pretest scores and correspondingly higher posttest scores.

However, as reported, there was a decrease between pre and posttest scores

among the comparison group Fathers. None of the Fathers' mean scores in the

treated groups were above 40. Figure 5.13 provides a visual representation of

the Fathers' Social Desirability subscale pre and posttest means.

Thus, all Fathers who participated in treatment increased their level of

Social Desirability at the conclusion of therapy, whereas Fathers in the

nontreatment, comparison group decreased their perceived level of Social

Desirability.

In considering the findings on the Social Desirability subscales, the results

should be viewed with caution for three reasons. First, there were scores for

only 10 Fathers in the comparison group. Second, the reliability scores on

Social Desirability are lower than for the Adaptability and Cohesion subscales.

Third, according to the test developer, mean scores above 40 (attained only in

the comparison group pre and post) are considered to represent an idealized

picture of the family. Therefore, it is the position of Olson, et. al (Shaffer, 1993)

that where scores exceed 40, the higher the score the lower the reliability for this

self report instrument. Such higher scoring individuals tend to respond in a way

that they believe to be a more socially acceptable and desirable response, rather

than their true response.

The comparison group Fathers, both pre and post, scored in the

unreliable, idealized range. Alternatively, it might also be tenable that their

extremely positive family picture was related to the possibility that this


704

comparison group's Fathers were different from the treated group Fathers'.

Comparison group means scores could, for example, reflect that these Fathers,

or even their families, did not need treatment as much as the participants in the

clinical groups. It is of note that, while not in the above 40 idealized range,

Mothers and Identified Clients in the comparison group also had the highest

pretest Social Desirability scores among the four experimental samples. Lastly,

this finding could also be the result of the fact that these Fathers, as well as the

other family members, did not obtain therapy which may have positively affected

their sense of family pride and well being.

In sum, both the pre and posttest scores for Fathers in the comparison

group were substantially higher than in the treated groups. Regardless of what

factors contributed to the result, Fathers' in the comparison group were different

with regard to Social Desirability.

Identified Clients scored with greater Social Desirability at the conclusion

of treatment in all three of the treated groups. Scores for clients in the

comparison group decreased slightly at posttest. Again, Identified Clients in the

comparison group had higher Social Desirability pretest scores which were

maintained at the posttest. Pretest mean scores were not within the range of

positive regard for the Bowen and Haley treatment groups, and were just slightly

in the positive range for the Satir group. Figure 5.14 provides a visual

representation of the Identified Clients’ Social Desirability subscale mean scores.

In effect, Identified Clients in the comparison group, at the time of the

pretest, scored with a higher mean level on the Social Desirability subscale,

while those in the three treated groups scored at a lower level. Thus, while

clients in the comparison group sample scored with a higher mean score on the


705

Social Desirability subscale, both pre and post, only those in the treated samples

increased their mean scores at the completion of treatment.


)

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745

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Winter, J. E. & Bjornsen, C. (1991). Selected outcomes of Bowen therapy with

families of juvenile offenders. American Family Therapy Association

Newsletter. 44. 33-34.

Winter, J., & Duke, J. (1973). Family counseling staff development. Richmond,

VA: Division of Justice and Crime Prevention.

Winter, J. E., & Parker, L. R. E. (1991). Enhancing the marital relationship:

Virginia Satir's parts party. Journal of Couples Therapy. 2, 59-82.

Reprinted in B. J. Brothers (Ed.). (1991). Virginia Satir: Foundational

ideas (pp. 59-82). New York: Haworth.

Winter, J. E., & Parker, L. R. E. (1992). Enhancing the marital relationship. In

G. F. Muller (Ed.), Virginia Satir's Waoezum Wachstrum. Munich,

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New York: Basic Books.


VITA


Joan E. Winter, LCSW, Ed.S.

2910 Monument Avenue Richmond, Virginia 23221-1404

(804) 355-6876

Personal Information:

Born: Aiken, South Carolina, February 24, 1947 Marital Status: Married, no children

Education:

Arizona State University, Tempe, Arizona BACHELOR OF SCIENCE, June, 1970 Major: Sociology

Virginia Commonwealth University, Richmond, Virginia Graduate School of Social WorkMASTERS OF SOCIAL WORK, May, 1977, with Highest Honors Thesis: "The Phenomena of Incest"

College of William and Mary, Williamsburg, Virginia Counseling DepartmentEDUCATIONAL SPECIALIST, December, 1989

College of William and Mary, Williamsburg, Virginia Counseling Department DOCTORATE IN COUNSELING, Ed.D., 1993 Dissertation: "Selected Family Therapy Outcomes with Bowen, Haley, and Satir"

Licensure:

Clinical Social Worker, State License #00904000350 Examiner, State of Virginia, Licensed Clinical Social Worker Board of Behavioral Sciences, Approved Supervisor,

State License #2511004 National Register of Clinical Social Workers, #015272 Diplomate of Clinical Social Workers


Joan E. Winter

Memberships

Phi Kappa Phi National Honor Society National Association of Social Workers Academy of Certified Social WorkersAvanta Network, International Family Therapy Faculty, Executive

BoardAmerican Association of Marriage and Family Therapy-Clinical

Member; Approved Supervisor Mental Health Association PAIRS Professional Leader

Special Awards, Honors

Outstanding Young American Woman, 1976 Virginia Commonwealth University Scholarship

Award, 1977National Advisory Committee on Family Therapy Research, National

Institute of Drug Abuse "Distinguished Contributor," Virginia Department of Corrections, 1981 Who's Who in the South and Southwest, 1986 World's Who’s Who of Women, Ninth Edition

Areas of Special Interest

Marital and Family Therapy Incest, Child Abuse HypnosisPAIRS Professional Leadership Training for Couples Residential Treatment Programs Juvenile Delinquency and Family Systems Organizational Development Education and Training of Therapists Treatment Outcome and Process ResearchLegal Consultant and Expert Witness for Divorce, Child Custody, Child

Abuse, Sexual Offenders, and Criminal Cases Supervision of Therapists (under the auspices of state and national

licensing boards and organizations, for maintaining licensure and rehabilitation)


Joan E. Winter

Professional Experience '

1983-Present Director, Family Institute of Virginia, Inc., 2910 Monument Avenue, Richmond, Virginia 23221

Responsibilities include administration, supervision and training for a multi-disciplinary team of therapists (8). Supervision of clinical research, training and educational services. The Family Institute of Virginia, additionally, has an on-going training program for therapists and includes 30 students per year. Also, provide direct clinical sen/ices for individual, marital and family counseling, and clinical consultations and supervision. Consultant to attorneys, judges, and provide court testimony.

1978-Present Executive Director, Family Therapy Reserach Project, under the auspices of the Virginia Department of Corrections, 4615 West Broad Street, Richmond, Virginia 23230.

Administer and coordinate a four-year family therapy treatment and training research grant for the Department of Corrections. Purpose was to determine what models of family therapy are effective with juvenile delinquents and their families with 188 families in the study sample. Also, what methods of staff training and development are necessary to create an effective therapist. Jay Haley, M.A., Murray Bowen, M.D., and Virginia Satir, D.S.W., each coordinated a treatment and training module which was evaluated.

1981 -Present Co-Trainer with Harry Aponte, two Clinical Training Programs, four days per month on "The Person and Practice of the Therapist." Thirty students under the auspices of the Family Institute of Virginia and licensure supervision through the Virginia Board of Behavioral Sciences.

1977-1983 Co-Director, Family Institute of Virginia, Inc., 1800Staples Mill Road, Richmond, Virginia 23230.

Responsibilities included individual, family and group therapy with children and adults. Consultation and training on a contract basis with health delivery systems


Joan E. Winter

1981-1982

1982-1983

1976-1977

1975-1977

1976

1975-1976

(hospitals, mental health, corrections and welfare) in family and individual therapy, incest, juvenile delinquency, and substance abuse.

Member, National Advisory Committee, "Family Systems Research" Law Enforcement Assistance Administration. Advisor of two major LEAA grant projects.

Member, National Institute of Drug and Alcohol Abuse, National Advisory Committee, "Family Therapy and Research."

Therapist, Counseling Center, Virginia Commonwealth University, Richmond, Virginia. Field placement.

Responsibilities included individual, marital, and family therapy with students and faculty. Primary emphasis on direct clinical practice and supervision of clinical work.

Therapist, Family and Group Therapy Associates, 4905 Radford Avenue, Suite 211, Richmond, Virginia 23230.

Part-time employment (10-15) hours per week. Responsibilities included individual, family and group therapy.

Therapist, Outpatient Clinic, Medical College of Virginia, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia. Field placement.

Community Residential Care Specialist, Virginia Department of Corrections, Division of Youth Services, 1500 Forest Avenue, Richmond, Virginia 23229

Responsibilities included development and supervision of all community residential care treatment programs (14 programs including detention homes, group homes, foster care and halfway houses) in Central Virginia. Supervision of program directors and interns (psychology doctoral interns, graduate social work interns, VISTA volunteers) and general program administration.


Joan E. Winter

Experience in grant development and administration, community and public relations, program and staff development, implementation, research evaluation, and certification.

1975-1976 Coordinator, Family Therapy and Staff Development Training Program, Virginia Department of Corrections, Division of Youth Services, 301 Turner Road, Richmond, Virginia

Coordination of a grant for inter-agency training of juvenile justice system personnel. Responsibilities included grant development and administration, selection of staff and inter-agency family counseling program coordination (courts, detention homes, and group care facilities). Also, teaching one third of the seminars, coordinating the curriculum, and hiring of six other family therapy instructors.

1973-1975 State Supervisor of Group Care, Virginia Department of Welfare and Institutions, 501 South Belvidere Street, Richmond, Virginia

Supervisor of all state operated community residential care facilities. Responsibilities included recruitment, supervision and retention of staff, development of operating procedures and manuals, supervision of graduate students (psychology doctoral interns, graduate social work administration students), program development with localities (county managers, judges, city councils), coordination of volunteer advisory boards and services, and program evaluation.

1971-1973 Director, Ladies Mile Manor, Halfway House, Virginia Department of Welfare and Institutions, 3007 Chamberlayne Avenue, Richmond, Virginia

Responsibilities included initiation and development of the first community residential care facility for girls in Virginia. Coordination of supervision of a multidisciplinary staff and students, program and grant administration, and evaluation.


Joan E. Winter

1970-1971

1969-1970

Counselor, Arizona Job Colleges, Casa Grande, Arizona.

Individual, family, group, and play therapy with a multiracial (Indians, Chicanos, Blacks, Anglos) residential program for poverty families in Arizona funded by the Ford Foundation, Department of Vocational Rehabilitation and the Department of Health, Education and Welfare. Responsibilities also included supervision and teaching of minority paraprofessional counselors.

Counselor, Child Psychiatry Hospital, Arizona State Hospital, Phoenix, Arizona.

Individual, group, and family therapy with hospitalized children and adolescents under the supervision of MSW's and M.D. Responsibilities included supervision of youths; individual, group, and family counseling; and development of a therapeutic community model.


Joan E. Winter

Specialized Training

1970-1989 Virginia Satir, D.S.W. Ongoing therapy training and supervision. Includes five family therapy residential month-long seminars and other shorter workshops (15). Also, one month-long seminar devoted to family reconstruction, 1976.

Harry Aponte, M.S.W., private practice, former Director of Philadelphia Child Guidance Clinic. Ongoing family therapy training and individual supervision.

Milton Erickson, M.D., 7715 North 12th Street, Phoenix, Arizona. Training and supervision in clinical hypnosis and therapy. (At least six weeks of direct training with Dr. Erickson before his death.)

1980-1985 Attendance at the Milton Erickson Foundation Hypnosis conferences.

1976-Present

1976-1979

1972-1990

1977-Present

1980-Present

1985

Murray Bowen, M.D., Director of Georgetown University Family Psychiatry Center. Ongoing monthly family psychotherapy seminars at the Medical College of Virginia, Richmond, Virginia. Also, presentation of my own family of origin research to Bowen and seminar participants (1972-1980). Continued consultation, upon request (1981-1990).

Avanta Network. Family Therapy Faculty Network. Intensive organizational and family systems training under the invitation and leadership of Virginia Satir. Includes direct supervision of training methods and skills. Also "International Human Learning Resource Network" conferences, coordinated and by invitation of Virginia Satir, 1972, 1985.

Albert Pesso, M.S. "Psychomotor Workshop." A series of 3-day workshops on "Psychomotor Therapy" which incorporates body movement and psychotherapy.

Nicholas Groth, Ph.d. "Assessing and treating sex offenders." Workshop conducted at the Medical College of Virginia, Richmond, Virginia.


Joan E. Winter

1990-1991

1984

1984

1984

1982-1988

1978-1984

1976,1983

1982

1982

Lori Gordon, M.S.W. "PAIRS Professional Leadership Training." 100 hour course for providing psychoeducational intervention for couples, Fort Lauderdale, Florida.

Humberto Maturna Ph.d. “The Maturna lectures: A thorough exposition of Maturna therapy." Symposium conducted at the Eastern Virginia Medical School, Norfolk, Virginia, August.

Paul Watzliwick, Ph.d. The problems of change: The change of problems, symposium conducted at the Eastern Virginia Medical School, Norfolk, Virginia, June.

John Thie, C.P. "Touch for Health" training program and certificate. Taught by originator of the concept. Palo Mesa, California, April 1984.

Carl Whitaker, M.D. Three 3-day family therapy seminars. One under the auspices of The Family Institute of Virginia; 2-week intensive family therapy clinical training program, seminars, Gabrieta Island Garden.

Fred Duhl, M.D., Bunny Duhl, Ph.D., Co-Directors, Boston Family Institute. "Developing creative methods for teaching therapists," March 22-26, 1978, Boston, Massachusetts. "Training for Trainers II," August 1983. "Training for Trainers III," August 1984.

Lynn Hoffman, M.S.W., Coordinator of Rochester University Family Therapy Program, New York.Workshop on "Structural Family Therapy," March, Richmond, Virginia. One-day workshop, 1983, Williamsburg, Virginia.

Irma Lee Sheperd, M.S. Atlanta, Georgia. Small group training, four days. Family Institute of Virginia,Richmond, Virginia.

Robert Goulding, M.D., Mary Goulding, M.S., private practice. "Gestalt therapy and transactional analysis."Five days, Family Institute of Virginia, Richmond, Virginia.


Joan E. Winter

1979-1980

1974-1979

1978

1978

1977

1975-1976

1972-1991

1974-1975

Richard Bandler, Leselie Cameron Bandler. "Onbeing an agent for change," comparative study of therapeutic and teaching interventions. Washington,D.C., five days in 1980.

Vincent Sweeny, M.D., Co-Director of the Center for Study of Human systems, Chevy Chase, Maryland. Organizational development, therapeutic consultation and family therapy supervision.

Jay Haley, M.A., Director of Family Therapy Institute of Washington, D.C. "Problem solving family therapy," weekly seminar, January-May, 1978.

James Framo, Ph.D., Psychology Professor, Temple University, Philadelphia, Pennsylvania. "Family therapy with multiple couples group," 3-day workshop in May, Chapel Hill, North Carolina.

Hank Giaretto, M.A. Director of Sexual Child Abuse Treatment Program of Santa Clara County Court, San Jose, California. One month (March) training and research at this incest treatment and training facility, which has treated over 800 sexually abusing families.

Thomas Fogarty, M.D., Center for Family Learning, New Rocheiie, New York. Two 3-day family therapy seminars, Richmond, Virginia.

Yetta Bernhard, M.S. Family and couple training. "Aggression and fair fight training." A series of 3-day workshops under the auspices of Oasis Growth Center, Evanston, Illinois and Northwestern University. (1972- 1974), Ongoing training and consultation (1975-1992).

Peggy Papp, M.S.W., Center for Family Learning, New Rochelle, New York. Two family sculpting workshops, Richmond, Virginia.


Joan E. Winter

Consultations, Lectures, W orkshops

1980-Present

1979-Present

1975-Present

1983-1984

1979

1979

1977-1979

Expert Witness and Consultant to lawyers and judges regarding child custody, divorce, and criminal cases.Also clinical evaluations and interventions strategies, pre- and post-trial. Involved on a regular basis with several lawyers, Commonwealth Attorneys, and judges.

To summarize, numerous workshops on family therapy, incest, and training and development of therapist (at least 15 per year). Also, television appearances on child abuse, incest, and family problems.

Family Therapy Consultant and Planner, Virginia Department of Corrections, Richmond, Virginia. Included development of a family therapy program design for the State of Virginia, staff training and development.

Organizational Consultant, St. Catherine’s School, Richmond, Virginia. Provided clinical and residential program consultation to 150 students. Worked extensively with staff, faculty, and school administration regarding organizational development.

Dean of Students or Head Master for boarding program with Richmond Juvenile Court, Family Counseling Program, Richmond, Virginia. "Working with incest families," May 28.

Family Therapy Network Symposium, Maryland. "Research in family therapy models: Communications, systems, and structural," May 12.

Ninth District Court Services Unit, Providence Forge, Virginia. Family therapy and staff development consultant.

1978

1978

Virginia Council of Social Work Education, Roanoke, Virginia. "Incest families," September 29.

Piedmont Child Abuse Council Symposium, Burlington, North Carolina. "Psychotherapy with incest families," September 22.


Joan E. Winter

1978

1978

1978

1978

1978

1977-1978

1977

1977

Virginia Department of Mental Health and Retardation, "Family therapy and the alcoholic system," Syria, Virginia, June 14-16.

Virginia Department of Corrections, Division of Youth Services and the University of Virginia, Department of Continuing Education, Training Academy, Waynesboro, Virginia. "Working with incest families," June 20-21.

Featherstone Growth Center, Amelia, Virginia. "Family therapy," and "Family reconstruction," 3-day workshops for mental health professionals, April, June.

University of Southern Mississippi, Psychology Department. "Marriage and family counseling," summer course, May 23-26.

Henrico County Public Schools, Henrico, Virginia."Family therapy with child focused families," February 20- 21 .

Southside Area Mental Health Clinics, Petersburg, Virginia. "Family therapy," 9-month course taught to mental health practitioners.

Marin County Juvenile Court, Marin, California. "Staff development and family therapy skills," March.

Virginia Department of Welfare, Southwest Regional Office, Lynchburg, Virginia. "The incest phenomena," workshop, August.


Joan E. Winter

Grant Awards

1978-Present Project Director, "Family Systems Development Grant," Law Enforcement Administration Agency, 78-A4496J.

1975-1976 Project Administrator, "Family Therapy and StaffDevelopment Program," Law Enforcement Assistance Administration.

Research and Publications

1973 Winter, J., & Duke, J. (1973). Family counseling staffdevelopment. Richmond, VA: Division of Justice and Crime Prevention.

1977 Winter, J.E. (1977). The phenomena of incest.Unpublished master's thesis. Virginia Commonwealth University.

1979 Winter, J.E. (1979). A conceptual framework for familytherapy treatment and training research: Systems, strategic, communications. Symposium paper at the Family Therapy Practice Network, Washington, D.C. (Also published in the proceedings in The synopsis of family therapy practice with M.S. Kolevzon.

Winter, J. (1979a, July). Interview with Murray Bowen and Bowen Theory therapists. Unpublished manuscript, Georgetown Family Center, Washington, DC.

Winter, J. (1979b, November). Interview with Jav Halev and Strataic Family Therapy therapists. Unpublished manuscript, Family Therapy Institute of Washington,D.C., Washington, D.C.

1980 Winter, J. (1980. November). Interview with VirginiaStair and Process Model Avanta therapists. Unpublished manuscript, Richmond, Virginia.

1981 Kiesler, D.J., Sheridan, M.J., Winter, J.E., and Kolevzon,M.S. (July, 1981). Family therapist intervention coding system (FTICS). preliminary final version (research report). Family Institute of Virginia and the Virginia Department of Corrections, Grant #78-A449J6.


Joan E. Winter

1986

1987

1988

1989

Kiesler, D.J., Sheridan, M.J., Winter, J.E., and Kilevzon, M.S. (July, 1981). Family therapist intervention coding system (FTICST Unitizing manual: Identification of thought units (research report). Family Institute of Virginia and the Virginia Department of Corrections,Grant #78-A4496J

Kiesler, D.J., Sheridan, M.J., Winter, J.E., and Kilevzon, M.S. (1981). Family therapist intervention coding system (FTICS), nonverbal coding system (research report). Family Institute of Virginia and the Virginia Department of Corrections, Grant #78-A4496J.

Winter, J.E., and Aponte, H.J. The family life of psychotherapists: Volume 3, No. 3, Fall, 1987. And in clinical implications. Journal of Psychotherapy and the Family. Florence Kaslow (Ed.). The family life of therapists. Haworth Press, 1987.

Aponte, H.J., and Winter, J.E. The person and practice of the therapist: Treatment and training. Journal of Psychotherapy and the Family. Volume 3, Spring 1987. And in M. Baldwin and V. Satir (Eds.). The use of self in therapy. Haworth Press, 1987.

Winter, J.E., & Aponte, H.J. (1987). The family life of psychotherapists: Treatment and training implications. Journal of Psychotherapy and the Family. 3, Fall, 1978. Reprinted in F. Kaslow (Ed.). (1987). The family life of therapists. New York: Haworth.

Winter, J. (1987, April). Meeting with Bowen Theory therapists. Unpublished manuscript, Georgetown Family Center, Washington, D.C.

Winter, J.E. (1988). Family therapy outcomes with Bowen. Halev. and Satir: Engagement, dropout, completion, and recidivism. Unpublished manuscript, College of William and Mary, Williamsburg, Virginia.

Winter, J. E. (1989, August). Meeting with Murray Bowen. Unpublished manuscript, Georgetown Family Center, Washington, D.C.


Joan E. Winter

1991

1992

Winter, J. E. & Bjornsen, C. (1991). Selected outcomes of Bowen therapy with families of juvenile offenders. American Family Therapy Association Newsletter. 44. 33- 34.

Winter, J. E., & Parker, L. R. E. (1991). Enhancing the marital relationship: Virginia Satir’s parts party. Journal of Couples Therapy. 2, 59-82. Reprinted in B. J. Brothers (Ed.). (1991). Virginia Satir: Foundational ideas (pp. 59- 82). New York: Haworth.

Winter, J.E. (1992). Family Research Project: Family therapy outcome study of Bowen, Halev. and Satir. Unpublished manuscript, Richmond, Virginia.

Winter, J.E. (1992). In press. Satir process model: Overview of theory. M. Elkhaim (Ed.). Belgium.

Winter, J. E., & Parker, L. R. E. (1992). Enhancing the marital relationship. In G. F. Muller (Ed.). Virginia Satir's Wagezum Wachstrum. Munich, Germany: Junfermann.

permission of the copyright owner. Further reproduction prohibited without permission.

ABSTRACT


ABSTRACT

Joan Elizabeth Winter, Ed.D

The College of William and Mary, April, 1993

Chairman: Charles O. Matthews, Ph.D.

The purpose of this study was to investigate three distinct, and well-

known models of family therapy: Bowen Theory, Haley's Strategic Family

Therapy, and the Satir Process Model. Specifically, the question that was

explored concerned what family therapy approaches achieve what types of

engagement, dropout, completion, satisfaction with treatment, locus of control,

and family functioning outcomes with what kinds of delinquent families. Further,

what effect do traditional court services, with no family intervention, have on a

similar sample of delinquent youths and their families. The sample (n = 249)

was derived from 14 Virginia juvenile court service units.

General systems theory provided the theoretical framework for the three

distinct types of family therapy explored. A "major research priority" for the field

of family systems theory and practice was identified as the need to evaluate

"family therapy methods that already have had widespread clinical and training

impact" (Gurman and Kniskern, 1981, p. 756). While family therapy has attained

significant positive outcomes, there remain substantial variations between

methods of treatment and training. Prior research has not focused on "pure

applications of given treatment models." (p. 745). This study represents the first,

and only, investigation of family therapy outcome research to utilize exemplars of

three distinctly different and prominent approaches to family change. Treatment

was provided by therapists (n = 48) who were selected, and supervised or

763

permission of the copyright owner. Further reproduction prohibited without permission.

764

trained by Murray Bowen, Jay Haley, and Virginia Satir. Each pioneer was able

to personally direct the particular manner of treatment implementation.

A non-equivalent, quasi-experimental design with pre and posttest treated

(jl = 188) and comparison (n = 61) groups was employed. Independent

variables included the treatment interventions (Bowen, Haley, Satir, and

comparison group). The dependent variables included seven criterion variables

of clinical engagement, clinical dropout, completion, satisfaction with treatment,

locus of control, and family functioning. Data were analyzed by way of chi-

square, two-way analysis of variance, and repeated measures analysis of

variance statistical procedures.

Results indicated a significant difference in Engagement between the

Bowen and Haley models (<.005), and between the Satir and Haley models

(<.001). The Bowen (91.2%, n = 52) and Satir (93.7%, n = 59) groups engaged

significantly more families than the Haley (67.6%, n = 46) group. Results also

indicated a significant difference in clinical Dropout between the Satir and Haley

models (<.001), and between the Satir and Bowen models (<.001). The Satir

(5.1 %, n = 3) group had fewer premature terminations than the Haley (60.9%, n

= 28), and Bowen (36.5%, n = 19) treatment groups. There were no statistically

significant differences between the Haley and Bowen Dropout samples.

In addition, results indicated a significant difference in Completion

between five of the pairwise comparisons. Findings revealed a significant

difference in Completion between Satir and Bowen (<.001), Satir and Haley

(<.001), and Satir and the Comparison group (<.001). Moreover, there were

differences between Bowen and Haley (<.001), and between the comparison

group and Haley (<.001). The Satir group completed with the highest number of


765

families (88.8%, n = 56), followed by the comparison group (59%, n = 36), the

Bowen completed sample (57.9%, n = 33), and then the Haley (26.5%, n = 18)

treatment group.

The Rotter Internal-External Locus of Control, in a repeated measures

analysis of variance, resulted in a significant effect for Time. Thus, at the end of

treatment, parents had lower mean scores indicating a move toward being more

internally directed.

The Family Adaptability and Cohesion Evaluation Scales, in a repeated

measures analysis of variance for three subscales, resulted in some significant

findings, specifically: Identified Clients' Cohesion subscale (Group effect);

Mothers' Social Desirability (Group effect); Fathers' Social Desirability (Group

effect); and Identified Clients' Social Desirability (Group and Time effect). In

general, follow-up testing revealed that there was a difference in the pretest

scores for the comparison group which were maintained over time, to the

posttest. Follow-up testing also revealed differences between the three treated

groups for some of the subscales.

The Satisfaction with Outcome subscale, which evaluated the family

members' perceptions regarding treatment outcome revealed significant effects

for Group and Person on a two-way analysis of variance. For the Group effect

follow-up testing indicated that families were more satisfied with the Satir

Process Model than Bowen Theory (<.001). For the Person effect, follow-up

testing revealed that Mothers were more satisfied with treatment than the

Identified Clients (<.001), and that Fathers were more satisfied than the

Identified Clients (<.002).


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Within the Satisfaction with Therapist subscale, which evaluated the

family members’ level of satisfaction with the clinician who provided treatment,

statistically significant differences were found for Group, Person, and Group and

Person Interaction on a two-way analysis of variance. Analysis of the interaction

found 15 differences among 36 paired comparisons. In general, results

indicated that all family members were more satisfied with the Satir Process

Model therapists, than with the Bowen and Haley clinicians. There were a

particular difference between the Identified Clients in the Satir group and those in

the Bowen and Haley treatment models. Parents in the Bowen and Haley group

were more satisfied than the Identified Clients in these respective groups.

Qualitative data with regard to Satisfaction with Treatment was also

analyzed. Herein, it was revealed that both Mothers and Fathers were quite

satisfied with the treatment they received. Overall, the Bowen and Satir families

were satisfied with the educational component of the treatment they received.

Families were dissatisfied with the some aspects of the treatment they received

in the respective groups, in particular: Bowen Theory: exclusion of the Identified

Client from therapy: Strategic Family Therapy: unknown observers on the other

side of mirror engendered a perception of vulnerability and lack of confidence in

the therapist; Satir Process Model: the brevity of treatment received within the

confines of the research project was perceived as a shortcoming.

The study attempted to fill a void in the family therapy outcome literature

by evaluating three distinct models of treatment. The research addressed a

priority set forth by Gurman and Kniskern (1981) who advanced that little, if any,

empirical evaluation has been conducted on "pure" family therapy models. By

having the direct participation of three vanguard theorists, including Murray


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Bowen, Jay Haley, and Virginia Satir, this research generated substantial data

on Engagement, Dropout, Completion, Satisfaction with Treatment, Locus of

Control, and Family Functioning.


Selected family therapy outcomes with Bowen, Haley, and Satir

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