Patterns of Social Functioning in Families with Marital and Parent-Child Problems 9781442653511

Table of contents :
Foreword
Contents
Preface
Project Staff
Introduction
I Role Concepts and Casework: Review of the Literature
II General Description of the Toronto Family Diagnosis Research Project, and Research Framework
III The Project Families
IV Social Class and Diagnostic Process: Caseworker and Client Assessment
V Social Class and Diagnostic Process: Paradigm Measures
VI Social Class Differences in Patterns of Role Functioning
VII Social Class and Role Differentiation: The Structure of the Division of Labour
VIII Conclusions and Implications
Bibliography
Appendices

Citation preview

PATTERNS OF SOCIAL FUNCTIONING IN FAMILIES WITH MARITAL AND PARENT-CHILD PROBLEMS In recent years the social work profession has been encouraging experimentation in casework practice for the purpose of developing a framework of concepts and theories concerning family diagnosis and treatment. Much of the theory behind this current trend seems to have remained theory: it lacks the ability to connect with experience. Many of the conclusions are based on material that is almost impossible to systematize because it relies on case histories, narrative accounts or information derived from studies using different kinds of measurements and techniques, few of them even roughly conforming to demands made by scientific methodology. The study reported in this book was conducted under the auspices of the Toronto Family Diagnosis Project, School of Social Work, University of Toronto. It is the first attempt to study a sample of client families with marital and parent-child problems using a systematic framework based on role-theory. The findings of the study are important and made more so by the consistency of the framework: the dimensions of family behaviour can be accurately studied because the techniques of observation used in this study are constant. This book is an impressive contribution to two areas of social work : it offers new observations regarding family life that will be of particular interest to professionals and researchers in the field of family and child welfare, and its technical framework will be of interest to all social workers. GERSON DAVID received his Ph.D. from the University of Pittsburgh in 1966. He also holds degrees from Madras University, Madras School of Social Work andSchool of Social Service Administration, University of Chicago. He was a Fulbright Scholar in the United States from 1958 to 1962, and before taking up his present position as Associate Professor of Social Work Research at West Virginia University in 1967, he served for more than four years as Director, Family Diagnosis Research Project, and Assistant Professor in the School of Social Work, University of Toronto.

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Patterns of Social Functioning in Families with Marital and Parent-Child Problems GERSON DAVID With Introduction by John C. Spencer

Published for

UNIVERSITY OF TORONTO SCHOOL OF SOCIAL WORK by

UNIVERSITY OF TORONTO PRESS

0

UNIVERSITY OF TORONTO PRESS 1967 Printed in Canada

FOREWORD Charles E. Hendry I take satisfaction and modest pride in composing this brief foreword. My association with the research exercise here goes back to 1958 when I initiated exploratory conversations with Professor Werner W. Boehm, then located in New York City as Director of the Curriculum Study for the Council on Social Work Education. What has occurred since is fully documented in the record which follows. Two points of significance deserve special comment. The first is that this research project is an attempt to bring together social work practice and social science in a collaborative research effort. The second is that such a demanding exercise requires, and in this instance has secured, the most responsible collaboration possible between university-based research specialists and agency-based social work professionals. More specifically, this research aims to apply a paradigm that would enable the translating of role concepts into quantitative form, in the study of family systems. The goal is to develop a tool which may be useful in measuring the ways in which members of a family perform their various roles, so that the family may be helped more effectively to cope with problems of social functioning. The research was carried on at the School of Social Work by a team working full time, with substantial support from the Department of National Health and Welfare, the Ontario Mental Health Foundation, the Harry M. Cassidy Memorial Research Fund, and Imperial Oil Limited. The Varsity Fund of the University of Toronto generously provided support toward publication of the report herein. The first three-year phase, now completed, is a study of a sample of 123 client families of the Family Service Association of Metropolitan Toronto who volunteered to participate. Information was sought on many of the activities which are a normal part of family living—child rearing practices: who performs certain tasks in the household; how things are decided in the house; and the feelings and expectations of the family members.

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Following analysis of the data obtained from the first phase, it was expected that the project would enter a second phase, beginning in April 1965, in the study of a sample of 300 families drawn from the general population. The purpose of the contemplated second phase was twofold. First, to describe role characteristics which would provide a basis for measures of role performance. With such data it would be possible to test a number of hypotheses and ascertain the significance of many patterns of family functioning. Second, to document the significance of particular social processes in the evolution of healthy as well as disturbed role functioning. Such information, it was hoped, would add to our understanding of the family as a role system. We have not yet been able to secure the funds for this very vital phase of the research project. However, the results of the research to date were shared at a Consultative Conference on September 20, 1965, in the Senate Chamber of the University of Toronto, held under the joint auspices of the School of Social Work and the Toronto Branch of the Canadian Association of Social Workers and attended by selected agency administrators, research personnel from government and private welfare agencies, and faculty members from the University. Also the project recently became internationally known when the Research Director, Dr. Gerson David, attended the International Conference on the Family in New Delhi, India, as a consultant to the section on "Family Research in Asia" and had opportunity to report on our research here. Research agencies both in the U. S. A. and in Canada have indicated interest in the research framework of the project and the instrumentation. The Mental Retardation Centre in Toronto, for instance, has been consulting with the Research Director regarding adaptation of the Project instruments for use in their research. Now with the publication of this report it is expected that the results of the Toronto Family Diagnosis Research Project will have wider dissemination for study and experimentation by interested investigators.

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CONTENTS FOREWORD by Charles E. Hendry PREFACE

v ix

PROJECT STAFF

xii

INTRODUCTION by John C. Spencer

3

I ROLE CONCEPTS AND CASEWORK: REVIEW OF THE LITERATURE

13

II GENERAL DESCRIPTION OF THE TORONTO FAMILY DIAGNOSIS RESEARCH PROJECT, AND RESEARCH FRAMEWORK

20

III THE PROJECT FAMILIES

42

IV SOCIAL CLASS AND DIAGNOSTIC PROCESS: CASEWORKER AND CLIENT ASSESSMENT

52

V SOCIAL CLASS AND DIAGNOSTIC PROCESS: PARADIGM MEASURES

70

VI SOCIAL CLASS DIFFERENCES IN PATTERNS OF ROLE FUNCTIONING

89

VII SOCIAL CLASS AND ROLE DIFFERENTIATION: THE STRUCTURE OF THE DIVISION OF LABOUR VIII CONCLUSIONS AND IMPLICATIONS BIBLIOGRAPHY

164 210 225

APPENDICES

I Item Analysis

236

II Reliability Test Results

244 vii

III Child Rearing—Inter-item Correlations

245

IV Chi-Square Results

260

V Child Rearing/Child Centredness Scale

261

VI Independence of Levels—Standard Scores

261

VII Independence of Variance Levels

264

VIII Independence of Content Areas on Variance Indices

266

IX Correlation of Caseworker Rating Schedules and Instrument Scores

270

X Correlation of Caseworker Rating Schedules— Global Evaluation with Area Evaluation

271

XI Results of Reliability Test for Problem Classification Scheme

271

XII list of Indices

273

XIII Tables Not in Text

275

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PREFACE

The Family Diagnosis Research Project was begun in an organized form on April 1, 1963, though its conception was planned some four years earlier. In December 1958, Dr. Werner W. Boehm, of the University of Minnesota, who was completing his report of a three-year curriculum study for the Council on Social Work Education, was awarded a grant by the Harry M. Cassidy Memorial Research Fund, University of Toronto School of Social Work, to design a research project which would provide a field test of his theoretical study of social casework. The broad basic framework was delineated by October 1960, and by April 1961 financial support was assured by a further research assistance grant from the Harry M. Cassidy Memorial Research Fund, a National Mental Health Grant from the Department of National Health and Welfare and a research grant-in-aid from Imperial Oil Limited. Because of difficulties in obtaining competent full-time staff, the project could not begin to function until August 1962, when Mrs. Mary Barnes, a social caseworker, was appointed to direct the research operation. For personal reasons she had to leave the project at the end of March 1963, when she was succeeded by the author, who had joined the staff of the project in mid-November 1962. In April 1963, Dr. Boehm, Principal Investigator, was appointed Dean of the School of Social Work at Rutgers University, and his withdrawal from the project followed. Dr. John Spencer, Professor of Social Work, University of Toronto, assumed the responsibility of Principal Investigator. The author, on his appointment as Project Director, sought the collaboration of Professor Irving Lukoff, Associate Professor of Social Work Research, Graduate School of Social Work, University of Pittsburgh, to identify practicable areas of research within the general framework of exploring role-based concepts in family diagnosis. Soon afterwards, decisions were made regarding specific aims of the research project. These were: (1) to explore the feasibility of a paradigm for measurement of role, which had been developed in the Family Study Project of Allegheny General Hospital in Pittsburgh, as a diagnostic, prognostic, and evaluative device in casework as applied to a Family Service Agency setting in Metropolitan Toronto; and ix

(2) to examine the extent to which there is agreement between the description of role operations of family members as tapped by the instruments and as they are seen by the worker, based on his clinical experience. An additional consideration was to assess the sensitivity of the instruments to measure change within the family from the point of view of shifts in role relationships over a period of time. Accordingly, during 1963-64, the role paradigm and the instruments described in a subsequent section of this report were adapted for the research study. Pre-testing work connected with the development of the questionnaires was concluded during the summer of 1963. The pre-test procedures were meant to test only the applicability of the main questionnaires to the Toronto population. After the collection and preliminary analysis of the resulting data, forms for caseworkers' ratings and schedules needed for the main study phase were constructed. Data collection was commenced by the Family Service Association of Metropolitan Toronto in September 1963. Caseworkers on the staff collaborated in collecting data from families selected from the agency clientele. The procedures connected with the datacollection process are discussed in a later section. Data collection continued until the end of June 1964. A total of 123 client families participated in completing the first administration of the questionnaires. Of these, 38 families completed the second administration of the questionnaires. Item analysis and reliability studies were conducted during September-December 1964, and the actual data analysis commenced in January 1965. Because of the late start in actual functioning of the project and the consequent changes in time schedule, an extension of three months was applied for to the Ontario Mental Health Foundation, which had continued the financial support given earlier through the National Mental Health Grant, and June 1965 was set as the termination date for the project. The Project staff is greatly indebted for the financial support and encouragement given by the Harry M. Cassidy Memorial Research Fund, which initiated the project, Imperial Oil Limited, the Department of National Health and Welfare, National Health Grants Program (Mental Health Grant #605-5-320), and the Ontario Mental Health Foundation (Grant #38). It is also greatly indebted to the University of Toronto and the School of Social Work for the use of its office space and facilities, and for x

opportunities afforded for consultation with members of the teaching staff. Especially helpful were Professors Minda Posen and Ruth Robinson and Miss Ann Jones who participated in coding connected with the reliability test for the problem classification scheme. Particularly valuable assistance was given by the Research Advisory Committee, which comprised selected faculty members of the School, the Department of Sociology, the Department of Psychiatry, and a casework practitioner representing the agency which served as the research setting. Special thanks are due to the members of the Board of Directors of the Family Service Association of Metropolitan Toronto, particularly the Presidents, Mr. Eric H. Johnston and later Mr. A. S. Carter; to Miss Lillian Thomson, and later Mr. William Kellerman, Executive Directors of the Association; to Miss Violet Munns, Director of Casework, who co-ordinated data collection in the field; and to the field staff of the agency for their splendid efforts in securing the participation of eligible families for the research. Without this valuable agency assistance the study could not have been carried through. Acknowledgment is gratefully made to the several Research Assistants who worked on the project: to Mrs. Alice Levine, who assisted in the designing of research instruments and the development and application of codes for the transfer of data to IBM cards; to Miss Serena Phillett, who participated in the planning for statistical analysis, as well as in the actual tabulation and analysis of the data; and to Mr. Frank Maidman and Mrs. Jane (MacKay) Wright, who gave valuable assistance during the final stages of data analysis and in the preparation of this report. Also in the preparation of the report we are deeply grateful to Professor Lukoff, Research Consultant, for his critical review of each section and the valuable suggestions he made at every stage for improvement. Nor could the work have proceeded so successfully had it not been for the enthusiastic encouragement and support given to the project at all times by Professor Charles E. Hendry, and the ready and proficient help with details of operation and the preparation and editing of reports given by Mrs. Florence Strakhovsky, Research Secretary of the Harry M. Cassidy Memorial Research Fund. Special credit is owing to Mrs. Helen Romanick for her skillful and painstaking typing of our copy for offset printing. Our debt is hereby gratefully acknowledged. Gerson David xi

PROJECT STAFF

Dr. John C. Spencer, Principal Investigator Professor Irving F. Lukoff, Research Consultant Dr. Gerson David, Research Director Mrs. Alice Levine, Research Assistant Miss Serena Phillett, Research Assistant Mr. Frank Maidman, Research Assistant Mrs. Jane (MacKay) Wright, Research Assistant RESEARCH ADVISORY COMMITTEE

Dr. A. John Farina Associate Professor of Social Work University of Toronto

Prof. Irving F. Lukoff Associate Professor of Social Work Research University of Pittsburgh

Dr. Charles E. Hendry Director School of Social Work University of Toronto

Miss Violet Munns Director of Casework Family Service Association of Metropolitan Toronto

Dr. A. M. Hood Director Toronto Mental Health Clinic

Prof. S. E. Rhinewine Associate Professor of Social Work University of Toronto

Dr. Robert James Professor of Sociology University of Toronto

Dr. John C. Spencer Professor of Social Work University of Toronto

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PATTERNS OF SOCIAL FUNCTIONING IN FAMILIES WITH MARITAL AND PARENT-CHILD PROBLEMS

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INTRODUCTION John C. Spencer

The subject of the Family Diagnosis Research Project is the diagnosis and measurement of role perception and role functioning among a sample of families who came for treatment to the Family Service Association of Metropolitan Toronto. The framework for this research and the methods of measurement were devised by Professor Irving Lukoff, now at the Columbia University School of Social Work. Professor Lukoff also acted as consultant to the Project. Family diagnosis, as experience has taught us, is both a difficult and a complicated process. It can involve not only many dimensions and segments of behaviour within the family but also the interrelationships between the family and family members and the wider society. It can, moreover, involve theories at different levels of abstraction and drawn from different disciplines. Research into the diagnostic process also raises the perennial difficulty of the contrast between the aims and methods of research and those of treatment. This contrast, leading not infrequently to conflict, has been well stated by George Romans^ in his discussion of the distinction between clinical and analytical science. In action, and in treatment, we behave clinically: here the model is the doctor's treatment of the patient. But an analytical science is for understanding, not for action. It is general but it is also abstract in the sense that it picks out a few of the many factors operating in a particular situation and describes systematically the relationships between these factors. Thus it is never easy for the caseworker to incorporate into his diagnostic framework for purposes of treatment the conclusions reached in a particular research project, The Advisory Committee of the Family Diagnosis Research Project was faced with a broad range of possible diagnostic theories as a basis for research. Its decision to concentrate on the measurement of role as one important element in family diagnosis is a logical one. For during the past decade there has iGeorge C. Romans, The Human Group (New York: Harcourt, Brace, 1950), p. 15. 3

been increasing professional recognition of role relationships both by caseworkers and psychiatrists at the same time as the family itself has become a focal point of treatment. There are several reasons why this development has taken place. Of these reasons one should mention first the consequences of social change on family roles and especially on the roles of husband and wife. Precise ideas of marital roles have become blurred in modern society, through the intense growth of urbanization, through changes in women's work and the child-bearing cycle, and through new relationships and division of labour between the sexes. Simpler societies, by contrast, have faced many fewer difficulties in the confusion of roles and in the greater uniformity of ideas over family norms. At the same time there has been a growing interest in the study of the family as a social group or a social system, and in the interrelationships between each individual and other members of the system. Just as the family is itself a subsystem of society, and as such closely linked with it, so also there are subsystems within the family: the marital relationship, the parent-child relationship, and the sibling relationship. These subsystems are in turn related to one another. It is against this background that the use of role concepts was gradually developed in schemes of family diagnosis and treatment. There is no need here to discuss the stages by which this process has occurred. Yet the concept of role, one must emphasize, is deceptively simple and its apparent simplicity has given rise to considerable misunderstanding in its use for purposes of treatment and diagnosis. It was the need to cut through the obscurity of the various ways in which it is actually used that led to the formulation of the paradigm which constitutes the basic instrument for this research. The particular way of looking at role here is through the measurement and analysis of consistency and discrepancy in the perception of role and of role performance. The broad assumption is that family problems, often calling for outside professional intervention and treatment, may arise through conflict over roles in the family, and also from the inability of family members, particularly the marital partners, to perceive the discrepancy. Although in this report we present no specific analysis of the relationship between types of family breakdown and types of role discrepancy, the need for their further study 4

is already indicated. It is the great merit of the Lukoff paradigm for the measurement of role that it is extremely precise in its delineation of the concept itself and in the methods of measurement which are applied to it, The report makes clear the variety of senses in which the concept of role has been used in the social sciences. In social work literature the concept has been widely used. The clinical use of role, however, carries with it the defects of its own virtues. It is often said that one of the great merits of the concept of role is that it provides a bridge or a link between the social prescription attached to a particular role and the feelings associated with its performance. Herein lies its great value to the caseworker, but at the same time this may be an important source of ambiguity over the sense in which the concept is employed. The Lukoff paradigm is designed, therefore, to bring greater precision to the use of the role concept which is commonly employed in so many different senses, and also to provide a sound basis for its measurement. There are five different levels of analysis to be distinguished and measured. What we believe and what we do are not necessarily the same. We do not necessarily translate into action our values and our standards. "Do what I say, not what I do" is a common maxim. We expect our children to behave in a particular way but by our own behaviour, whether consciously or unconsciously, we ipaake it difficult or impossible for them to do so. Nor do we always perceive correctly the standards which other role partners are communicating to us. One of the main objectives of this method of approach is to clarify and measure many areas of behaviour that are now only vaguely apprehended. For example, the communication system within a family is of primary concern to family treatment. In the case of a small closely-knit unit such as the family it is clear that relationships between husbands and wives and parents and children will depend a great deal not only on mutual agreement over expectations of behaviour but on the clarity with which such expectations are mutually communicated. Thus the five levels of this paradigm distinguish between: the self-standards or values which we hold (S), the way we actually behave (B), the standards we actually perceive in another family member (P), the standards which we expect the 5

other family member to observe (N), and what that other member actually does in response to our expectations (O). This research was carried out in a family casework agency with a sample of families who came to the agency for treatment. The classification of types of problems based on the judgments of the caseworkers was as follows: first, individual problems; second, family problems; and third, economic, health, environmental, and housing problems. Although this classification is of a very broad and general kind, it was useful for assessing these problem areas and relating them to length of treatment and worker-client agreement on problem areas. But the main emphasis in this report is placed on the problem of social class, and it is within the framework of class that the main analysis of discrepancies in family roles is carried out. For the selection of class as the central focus of the study there are good reasons. In the first place, there appear to be significant differences between families in different social classes, not only as regards family role structure but also in other important areas, such as the division of labour, and values and methods of child rearing. Secondly, there has been considerable argument in social work over the extent to which social workers, as a consequence of their own predominantly middle-class origins, are biased in the selection of clients, the nature of diagnosis, and the course of treatment. One great weakness in such discussions is that experience is usually adduced to support one or the other side of the argument. On the one hand, there is the view that social work agencies have concentrated on the poor and the lower class to the exclusion of the middle class family. On the other, there is the more critical charge that the lower class has been neglected by professional workers and has had to rely on the help of public welfare and the services of workers below the professional level. In instances where lower class families are accepted for treatment, the view has been expressed that treatment is quickly discontinued for a variety of reasons. It is clear that both these arguments cannot be true at the same time. Although it is obviously unwise to generalize from research in a single agency, there is important evidence from this first stage of the Family Diagnosis Research Project on the way in which the judgments of the caseworkers working with the families in this study were in fact related to differences in 6

social class. SOME GENERAL CONCLUSIONS AND THEIR MEANING FOR SOCIAL WORK

What do the findings of this research mean and what conclusions can be drawn from these findings for social work practice ? In answering the first of these two questions we must bear in mind that these findings are based on a sample of families who have turned to a family social work agency for help with problems that trouble them. Differences between the Classes There are important variations between the classes in the nature and extent of discrepancy or congruence in family roles. These variations are to be seen in several different contexts: first, in relation to the areas of behaviour; second, in the classification of families according to different patterns of division of labour, such as egalitarian, segmentalized, husband-dominant and wife-dominant; third, in the kinds of division of labour between the two spouses; and fourth, in the proportion of families who report marital satisfaction from their family life. Areas of behaviour The areas of family behaviour in which the congruence or discrepancy in roles was assessed were four in number: household tasks; affection (subdivided into sex and communication); child rearing (subdivided into three areas); and task assignment. The research showed that whereas for the middle classes the primary problem was in the areas of household tasks and child rearing particularly, for the lower class the main problem was in the area of affection, both as regards sex and in the communication of affection. Linked with these observations is the belief that in the process of acquiring middle class standards, women incorporate these standards in their value system more quickly than men. The hypothesis that an increase in the wife's expectations of order in the home and of greater signs of affection from her husband would lead to greater discrepancy in role between the spouses was accordingly tested and was generally found to be 7

supported. Division of labour A great deal has been written about the current trend in America towards egalitarianism in division of labour between the spouses, and this has been assumed to be typical of the middle class family. It has been contrasted with the much greater segregation of household tasks carried out by the spouses in the lower class American family. It is therefore surprising to find that in this study of Canadian families who have sought help from a family agency, a greater proportion of lower class families than middle class families are found to be egalitarian. Among the upper middle class the highest proportion are wife-dominant, followed by a large proportion of egalitarian and segmentalized families. These findings raise an important question for further study: To what extent are these differences from the expected model due to the fact that this is an agency sample, and to what extent do they arise from differences between Canadian and American patterns of family life ? Types of activities As regards the different kinds of division of labour between the spouses, we find the greatest evidence of egalitarianism in the sharing of activities by the spouses. Marital satisfaction The degree of marital satisfaction has been determined by the spouses1 approval of each other in the area of affectional behaviour. An inverse relationship between role discrepancy and marital satisfaction was hypothesized. This hypothesis was supported, but with one important exception. It appeared that differences in values between the two spouses were of much less importance in promoting marital satisfaction than was inconsistency in the way in which norms reflecting these values were sent and perceived. Inconsistency in communication, one might conclude therefore, is a greater incentive to marital dissension than inconsistency in the values themselves. Egalitarianism is certainly an important factor in marital satisfaction. A greater proportion of egalitarian families are 8

more likely to report marital satisfaction, followed by segmentalized, husband-dominant and wife-dominant families, in descending order, Egalitarianism, in fact, is a puzzling concept: it is not necessarily the simple ideal state towards which families are enjoined by the textbooks to strive. Social Class and the Social Worker Recent discussions, in both Canada and the United States, on the purpose and design of anti-poverty programs have raised once again the difficult question of how most effectively to help and to motivate members of the lower social classes. This general problem arises in a particularly acute form where the help of psychiatrist or of professional social worker is involved. In the field of psychiatry, studies have emphasized the complexity of giving psychotherapy to lower class patients. In social work, experiments with multi-problem families have prompted new methods of approach, but have also drawn attention to the obstacles to continuation of long-term treatment. The reasons for this may be several. The problem of communication arising from differences in language, with all that these differences imply in terms of expectations and of relationships, is one very important reason. * Another may be the consequences of economic deprivation, which may end for the lower class client in hopelessness and rejection of service offered at a clinic or an agency which is usually free. But whatever the precise reasons it is clearly of great importance to social work to have access to competent research data on the ways in which social workers perceive problems in families from different social classes and on differences in the course of treatment. It is of great interest, therefore, to read in this report of the Family Diagnosis Research Project that the caseworkers in the agency, while perceiving more individual and family problems in the middle class than in the lower class families, saw more economic problems in the lower class. An index of agreement between worker and client on the nature of the problem areas was calculated, and on the basis of this index the report points out that the lower the social class 2

Basil Bernstein, "Social Class, Speech Systems and PsychoTherapy", British Journal of Sociology, XV (1964), 54-64. 9

the higher the degree of agreement between worker and client. This was particularly noticeable in the case of problems classified as "individual only", "family only", and "economic only". It is important to ask ourselves the reasons why these differences should occur. In doing so, we should bear in mind another conclusion on this issue in the report. Using the paradigm measures, the research team assessed independently the differences in type and magnitude of the problems felt by families in the different social classes. They found that while for the middle classes the primary problem appeared to be in household tasks and in child rearing, for the lower class the greatest problems were felt to be in the area of affection, both in relation to communication as well as sex. This difference between the independent identifications of the problems by the research instrument and the assessment of problem areas by social workers in the agency is of particular interest. It has led the author of the report to speculate that the lower degree of agreement between worker and client in the case of the middle class families may result from the caseworker's being better able to perceive family and individual problems in the middle class families because of the latterTs ability to offer language cues regarding their problems. Or it may indicate the worker's own competence in psychodynamics and his greater ability to identify with the middle classes and thus to empathize with their problems. These factors may perhaps give rise to the tendency on the part of the caseworker to revise, and even to exaggerate, the "individual" and "family" problems in the middle class families. The worker may feel from her experience that it is in the middle class families that opportunities for working on "individual" and "family" problems are greatest. The same points of contrast between the families in the middle class and in the lower class are shown in two other contexts. First, in the case of prognosis, workers were asked to predict the likelihood of success in treatment with the families in the sample. The study concludes that their prognoses for the future success of treatment become less optimistic as social class decreases. Here we notice also that in each of the class groups, workers are less optimistic as they move from an abstract or global level to a prognosis on a more specific level of the discrete areas of family activity or on the basis of 10

individual family member functions. Second, in relation to social class and continuation in treatment, the report notes that lower class families only enter longterm treatment at the agency when their family problems, as measured by the research instrument, are particularly strong. Moreover, as regards the duration or continuation of treatment, the report observes that in every type of problem the actual length of treatment was again related to the social class of the family: the higher the social class, the longer the duration of treatment. One final comment on these conclusions is perhaps relevant here. It would be easy—but it would be wrong—to use these findings as a point of criticism of the social workers in the agency and to argue broadly about the workers1 bias in terms of class. It would be wiser perhaps to interpret these findings in the light of the workers1 own casework experience. It may well be that in an agency whose policy is not primarily to give economic assistance to families, the possibility of helping lower class families who live much nearer to the margin of subsistence is severely limited. For these families the material problems of economic stability inevitably assume a great importance by comparison with the interpersonal problems of relationships between the members.

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I ROLE CONCEPTS AND CASEWORK: REVIEW OF THE L I T E R A T U R E

Examination of social work literature discloses a great number of articles in which family members and their interpersonal dynamics are discussed. In many, the utility of looking at ISee, for example: Dorothy Aiken, "Teaching Family Diagnosis in the Social Work Curriculum", Social Service Review, XXXIV (March 1960), 42-47; Frances Beatman, "Family Interaction: Its Significance for Diagnosis and Treatment", Social Casework. XXXVHI (March 1957), 111-118; Samuel Finestone, "Issues Involved in Developing Diagnostic Classifications for Casework", in Casework Papers 1960 (New York: Family Service Association of America, 1960), pp. 139-154; Florence Hollis, "Casework Diagnosis: What and Why?", Smith College Studies in Social Work. XXIV (June 1954), 1-8; Carol Meyer, "Quest for a Broader Base for Family Diagnosis", Social Casework. XL (July 1959), 370-376; Celia B. Mitchell, "Family Interviewing in Family Diagnosis", Social Casework. XL (July 1959), 381-384; Victoria Olds, "Role Theory and Casework: A Review of the Literature", Social Casework. XTJTT (January 1962), 3-8; Howard J. Parad, and Gerald Caplan, "A Framework for Studying Families in Crisis", Social Work. V (July 1960), 3-15; Helen H. Perlman, "The Role Concept and Social Casework: Some Explorations", Part n, Social Service Review. XXXVI (March 1962), 17-31; Lola G. Selby, "Typologies for Caseworkers: Some Considerations and Problems", Social Service Review. XXXH (December 1958), 341-349; Frances Sherz, "Family Interaction: Some Problems and Implications for Casework", in Howard J. Parad, and Roger R. Miller, eds., EgoOriented Casework (New York: Family Service Association of America, 1963), pp. 129-144; Viola W. Weiss, "An Application of Social Science Concepts to Family Diagnosis", Social Casework. XL (July 1959), 376-380; Viola Weiss, and Russell Munroe, "A Framework for Understanding Family Dynamics", Parts I and n, Social Casework. XL (January and February 1959), 3-9; 80-87. 13

relationships in terms of role has been stressed. The concept of social role refers to social interaction, to a role system with one or more partners; it is not an intrapsychic concept, nor is it a substitute for other ways of viewing reality, or for psychodynamic theory. 2 Role theory is still in the process of adaptation and assimilation in practice. More specifically, in casework, educators like Werner Boehm and Helen H. Perlman have attempted to articulate some of the implications which role theory has for practice. Boehm asserts that the chief purpose of casework is to improve the client's social functioning, expressed through the performance of specified social roles. 3 Helen Perlman emphasizes the fact that a person's behaviour is both shaped and guided by the expectations that he and his culture have invested in the status and the major social roles he carries. 4 However, it is generally recognized that inconsistency in the use of certain social science concepts within the profession produces confusion and vagueness. Scott Briar, in a letter to the Editor of Social Service Review, criticizes the ways in which concepts are often used and misused in social work. 5 Commenting on the exchange of letters between Norman Herstein and Helen Perlman regarding the latters1 use of role concepts in social work practice, Briar refers to the danger of treating the abstraction as if it were the actual phenomenon. He illustrates this by reference to Herstein1 s rejection of the 2

Herman D. Stein, "Social Work and the Behavioral and Social Sciences: Reflections on Developments", Journal of Jewish Communal Service, XLI (Fall 1964), 16-28. ^Werner W. Boehm, The Social Casework Method in Social Work Education (Vol. X, A Project Report of the Curriculum Study) (New York: Council on Social Work Education, 1959). Helen Harris Perlman, "The Role Concept and Social Casework: Some Explorations", Part I, Social Service Review, XXXV (December 1961), 370-381; and Part II, XXXVI (March 1962), 17-31. 4 Helen Harris Perlman, Social Casework: A Problem-Solving Process (Chicago: University of Chicago Press, 1957), p. 22. 5 Scott Briar, Social Service Review, XXXVII (March 1963), 101-102. 14

relevance of the role concept in understanding the problem of the delinquent child who is acting out the unconscious wishes of the parent. 6 Briar rightly points out that Herstein loaded the dice in his favour by the way in which he posed the question, since his statement of the problem itself is a preferred conceptualization of the data that is presented as phenomenal reality. Also, referring to Helen PerlmanTs statement that l f . . . a role is experienced. It is felt right in the core of body and emotion11, 7 Briar again points out that Helen Perlman gets into similar difficulty by presenting as phenomenal reality her preferred conceptualization that "a role is experienced11. This sort of confusion, arising out of presenting conceptualizations as phenomenal realities, according to Briar, undermines the crucial issue of how to evaluate the relative advantages and disadvantages of alternative conceptual frameworks in understanding the presenting problem. He advances the proposition that a desirable criterion for testing the usefulness of any concept would be to ascertain whether it increases the social workerfs ability to explain and predict the behaviour under scrutiny. It is not enough merely to raise the question of the usefulness of a diagnostic concept and leave it there. In the absence of empirical evidence, no case can be made for the superiority of one concept over another. Thus it becomes all the more necessary to devise means for testing the usefulness of concepts, and this can only be done if practitioners study such concepts and try to apply them in practice. SIGNIFICANCE OF THE USE OF ROLE CONCEPTS IN CASEWORK

According to Werner Boehm, the concept of role is said to be the integrating concept of personal and social factors which define human behaviour. It is a useful concept, as it— describes the activities and tasks which an individual is expected to perform by virtue of his membership 6

Norman Herstein, Social Service Review, XXXVI (June 1962), 238-239. 'Helen Harris Perlman, Social Service Review, XXXVI (September 1962), 329. 15

in social groups and his participation in social institutions. It permits an examination of the way these tasks are actually performed in terms of social and individual factors which determine their performance. 8 Carol Meyer asserts that "social rolen has become one of the most integrative concepts in social work. 9 Like Nathan Ackerman, 10 Carol Meyer regards social role as nthe link between the personality and social environment, the culturally determined unit of individual adaptation, or the coming together of biological drives, ego-identity, and the demands of society". Thus she says that a mother may be viewed not merely in terms of internal psychodynamics but also as a carrier of several role functions, such as mother, wife, daughter, and wage earner. It is the business of the caseworker to discern and sort out the role conflicts of the incumbent in order to help the client shoulder and carry out the role in a more satisfying and effective manner. If we accept Boehm's and MeyerTs theses, that social role is a useful concept in that it enables us to examine the adequacy of role performance, a logical question that precedes such an examination is whether we know how to describe role itself. Is it as Norman Her stein asks, what the client thinks it is? or what the family thinks? or the worker? or the supervisor? Is it all of these together? Which version of role is to be kept in mind? Do perspectives about role shift in accordance with the situation ?H SOCIAL WORK PRACTITIONERS1 VIEW OF THE USE OF ROLE CONCEPTS

It is generally accepted that the problems presented to a caseworker in a social agency are usually role problems, such as breakdowns, conflicts, or lack of gratification which a person 8

Op. cit,, p. 97 (emphasis ours). 0p. cit. 10 Nathan Ackerman, The Psychodynamics of Family Life (New York: Basic Books, 1958), pp. 53-67. 11 0p. cit. 9

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is experiencing in carrying out various life roles. In the understanding of the diversities of these problems, role expectation is a significant factor for social work practice. Particular ways of behaving are regarded as appropriate or necessary for individuals in areas of social functioning—for example, as parent, as spouse, or as employer—and the incumbent is perceived in terms of the way his role performance is in conformity with group norms. For example, Viola Weissl2 primarily views behaviour from the perspective of ascribed roles, and exercises role judgment against the backdrop of a combination of the workerTs own and the community1 s perception of norms governing the particular status. Discussing the application of the concept of social role to the "R" family case, she states: "Although Mrs. R. saw herself as a successful wife and mother, she was actually not performing her ascribed social role in a mature manner. "13 Furthermore, Henry Haas*4 observes that in practice the caseworker usually reviews with the client the components of the roles which the latter is expected to fulfill and helps the client towards the modification of the role demands that confront him, or helps him to move into less stressful roles. The worker uses the role concept as a diagnostic tool to sensitize himself to the dynamics of role transitions and to consider more thoroughly the positions which clients occupy in the role system, the reciprocal privileges and obligations attached to the positions, and the effect of the client1 s role performance on the other members in the field of interaction, and vice versa. Henry MaaslS further states that the quality of role performance depends upon the capacities and motivations of the role incumbent and persons in reciprocal relationships with him. The 12

Op. cit. Ibid. , p. 379. 14 Henry S. Maas, Building Social Work Theory with Social Science Tools; The Concept of Role, Special Report 41, Research Department, Welfare Planning Council, Los Angeles Region, 1954, p. 12. 15 Henry S. Maas, "Social Casework", in Walter A. Friedlander, ed. , Concepts and Methods of Social Work (Englewood Cliffs, N. J. : Prentice-Hall, 1958), pp. 48-65. 13

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individual first learns, through his participation in primary groups, the expectations required of a given social role in the larger group and in the general community; and later, in the system of role relationships provided by the primary group, he prepares himself for meeting the role expectations. Yet another social work educator, Florence Hollis, points out that the behavioural expectations or norms applied to the incumbent vary with the position held by him. 16 For example, a man is expected to behave differently in the role of a husband than in the role he may assume in the occupational structure as a manager. Besides others1 expectations directed toward the incumbent, a full consideration of role should take note of incumbent^ actual performance and his own standards governing his role. Florence Hollis notes: "Astute diagnosticians have intuitively taken such expectations into consideration in evaluating behavior. "17 Emphasizing the cultural element in social role, Katherine Spencer regards social role as a useful tool of analysis in thinking about the cultural patterning of behaviour as applied to a specific position in social groups such as family, school, profession, church, or any of the less formal groups that make up society. 18 From the treatment aspect of role problem, Helen Perlman suggests that to help a person carry out a social role in new and more satisfying ways requires the best efforts of the caseworker. The strengthening of the clients ego-functioning, supported and infused by the worker-client relationship, is the essence of casework. The content for caseworker-client consideration is (1) the personTs feeling, thinking about, acting and interacting, in some problematic role; (2) the other person with whom, or circumstances with which, he is involved; and (3) the reality situation and potential gratification in that role. She further -'•"Florence Hollis, Casework: A Psychosocial Therapy (New York: Random House, 1963). 17 Ibid. , p. 186 (emphasis ours). 18 Katherine Spencer, "The Place of Socio-Cultural Study in Casework", in Socio-Cultural Elements in Casework: A Casebook of Seven Ethnic Case Studies (New York: Council on Social Work Education), pp. 10-11. (Mimeographed, undated.) 18

suggests that the concept of role, to be of use to a caseworker, must be viewed and under stood always in its fourfold dimensions, viz. , in terms of (1) actions and behaviour; (2) interrelationships between and among several people; (3) separate and joint ideas, expectations, and judgment of the attitudes and behaviour of self and others; and (4) emotional values or sentiments invested in action and behaviour. 19 From the above discussion it may be noted that caseworkers appear to use the concept of role as a tool for (1) diagnostic understanding (Henry Maas); (2) evaluation of role performance (Werner Boehm and Carol Meyer); and (3) assessing the focus of treatment (Helen Perlman). The difficulties involved, however, in this task of describing role operations were clearly implied by Dr. Ann Shyne, summarizing the discussion following presentation of a paper by Beatrice Werble, "The Implications of Role Theory for Casework Research": Incorporation into research of the role concepts that have found their way into practice was recognized to be extremely difficult because of the imprecision of the notions and the nature of the measurement problems involved. 20 The research aims of the Toronto Family Diagnosis Project stem directly from the above concern and address themselves to the task of helping to develop a tool for measurement of role which would have relevance for family-focused casework. This effort will help the practitioners to accumulate more precise information on family problems in terms of role discrepancy in the family system and will further serve as a set of clarifying ideas which should add a new dimension to clinical diagnosis and treatment.

19

Helen Harris Perlman, "Identity Problems, Role and Casework Treatment", Social Work Practice 1963 (New York: Columbia University Press, 1963), p. 185. 2Q Social Science Theory and Social Work Research (New York: National Association of Social Workers, June 8-12, 1959), p. 31. 19

II GENERAL DESCRIPTION OF THE TORONTO FAMILY DIAGNOSIS RESEARCH PROJECT, AND RESEARCH FRAMEWORK Casework practice has tended in recent years to become increasingly systematic in the elaboration of its psychosocial framework. The current trend in casework is from concentration upon the person as self to concentration upon the person in continuous social interaction with a view to helping him toward better social functioning. The problems of social functioning do not occur in a vacuum; they occur in the life of an individual as he develops in a society, and the study of breakdown in social functioning cannot reasonably be detached from a study of the social setting in which it occurs. Family is one social system which all would identify as most relevant to an individual's mental health because it is both the locus of childhood experiences and an important part of adult experience throughout the life span. From this viewpoint, the study of the family as an interactional unit should receive greater emphasis because such research can contribute to understanding of mental health and mental illness. The family has always been the concern of social casework in family and child welfare agencies. For all that, during casework1 s long period of preoccupation with psychodynamic theory, the family was chiefly seen as background or environment. The assumption was that aid to one troubled family member who applied for help would doubtless contribute to his family's welfare. This, however, did not always turn out to be the case. Today, the family is viewed as a dynamic role network in which, depending upon the diagnosed problem, two or more members are actively involved. Any single family member is seen as both actor and as being acted upon, and caseworkers today are increasingly engaged in joint interviews with two or three members involved in almost every family problem. Thus family diagnosis and family treatment are becoming areas of both methodological and theoretical explorations in casework. The Toronto Family Diagnosis Research Project is part of this

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larger effort at systematic exploration of family diagnosis and treatment. It has several research aims, viz., (1) to implement a rigorous research framework that attempts to delineate systematically interrelated concepts of role, as well as to identify role dimensions that would contribute to the systematic understanding of family systems; (2) to generate and test hypotheses concerning the nature of family activities; and (3) to develop precise, valid, and reliable instruments designed to implement the theoretical framework. This research is a study of families in treatment who present themselves at a Family Service Agency. The main task of the research is to describe the patterns of functioning of these families in terms of the paradigm for measurement of role performance developed earlier by Professor Irving Lukoff in connection with the Allegheny Family Study Project in Pittsburgh.l An important condition constituted the background for the research described here. The Family Service Association of Metropolitan Toronto, the research agency, showed interest in rigorous scientific research that might have practical utility for the family service field and at the same time contribute knowledge more generally to the field of social work. The agency is a non-sectarian voluntary social agency providing family counseling service, chiefly to families with marital and parent-child problems. At the time the research was undertaken, the agency served nearly 6,000 families each year, of whom about 60 percent were families with problems around family relationships, mainly marital. The major service offered to the clients of the agency is casework, and recently family group treatment has been introduced in selected cases. Family Service Association staff was eager to participate in the research program but also concerned that the research should not interfere with the offering of services to clients seeking help with family problems. The project research staff also shared this concern and it was agreed that only eligible families who were willing to participate in the research should be included in the study sample and that no form of compulsion should be used. -'•Irving F. Lukoff, A Research Framework for Family Analysis in a Group Treatment Setting, Family Study Project, Allegheny General Hospital, Pittsburgh, Pa., 1962. (Mimeographed.) 21

The central focus of the study was on four major activity areas, viz., household tasks, affection, child rearing, and task assignment, because these four areas of interaction have been generally found to be the ones in which marital or parent-child problems are likely to reside. SOURCE OF DATA

The data used in this research were derived mainly from questionnaires administered to a selected sample of 123 families from the case load of nine district offices of the Family Service Association of Metropolitan Toronto during the period September 15, 1963 to June 30, 1964. Data were collected by agency staff members. The sample was limited to families: (1) in which the client had appeared at the district office of the agency for a full-length standard intake interview; (2) which were composed of at least husband and wife occupying the same residence; (3) whose members spoke English and had no profound intellectual deficiencies; and (4) in which no member had a currently diagnosed psychosis. The criterion that the family should consist of at least both spouses was in accord with the research aim to develop and refine a tool for the measurement of role which would have relevance for family casework. The main questionnaires (content of which is discussed in a subsequent section) were completed by members of the eligible families who consented to participate in the research project. The research interviewer filled out the face sheet form (Form 1), which sought information on basic demographic and background variables. The data were coded from verbal responses given by husband and/or wife. In addition to the instrument questionnaires, a series of forms was completed by the caseworkers which provided information essential to the research. These were: (1) Information on eligible clients who had had at least one interview, their presenting problems, and reasons for their refusal to participate in the research project or their exclusion from participation. Data from this form were used in checking the representativeness of the sample. 22

(2) Tentative impressions of how the case would unfold in terms of (a) who in the family would become the client; (b) probable length of treatment; and (c) who would terminate the case, caseworker or client. (3) Clinical judgment of the worker regarding the relative standing of the husband and of the wife in the same areas of functioning investigated in the questionnaire and an assessment of the outcome of the case and a global evaluation of the functioning of the family as a whole at termination. RESEARCH FRAMEWORK The Family Diagnosis Project is committed to the development of a system of treatment that views the family as an organized and patterned social system. A research program that stems from this commitment has to develop a language and observational system that is relevant to this frame of reference and not simply adapt current research methodologies geared to alternate treatment modalities. It is necessary to set aside diagnostic and problem classification systems linked to individual treatment methods and to develop a system that can contribute to diagnosis, treatment methodology, and treatment evaluation more appropriate to family group treatment. Diagnosis, although a continuing process, generally precedes the prescription of treatment. However, diagnosis requires information and probing that differ from the treatment process. It is therefore necessary to adapt and devise methods that permit assessments relevant to family group treatment, rather than rely on interactional analyses borrowed and adapted from the schema of Robert Bales, Alex Bavelas, and others2 generally applied to small groups. These latter are part of a large number of experimental research findings available on 2

Robert F. Bales, Interaction Process Analysis: A Method for the Study of Small Groups (Cambridge, Mass. : Addison Wesley Press, 1949); Alex Bavelas, "Communication Patterns in Task-Oriented Groups", Journal of the Acoustical Society of America, XXII (November 1950), 725-730.

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the subject of factors related to structural and interactional patterns in small groups. Studies indicate a close, and in general, reciprocal relation between the flow of communication and specified structures in small groups, such as a prestige structure, a friendship or choice structure, and a power structure. The aim of our research program, however, is to get closer to an understanding of day-to-day family activities in terms of expectations in the real world as contrasted with those occurring in laboratory situations. The research model described here derives from a series of developments in role theory, small group analysis, communication theory, and the literature in group theory. From this tradition, a set of prescriptions has been advanced that permits the systematic collection of data in terms that facilitate translating hypotheses about role conflict, communication disturbances, and familial patterns into quantitative form. THE CONCEPT OF ROLE

Role theory suffers from imprecision in many of its basic concepts,'including norms, roles, role expectations, and role behaviour. Although possessing heuristic value, these concepts have been frequently defined in a variety of ways. The extreme variations in the definition of the term Mrolet! are highlighted by Neal Gross et al. ^ For example, there is still disagreement as to whether role refers to expected or actual behaviour. According to Theodore Newcomb, "the ways of behaving which are expected of any individual who occupies a certain position constitute the role . . . associated with that position". 4 For Kingsley Davis, however, role refers to "what an individual actually performs in a given position, as distinct from how he is supposed to perform".5 3

Neal C. Gross, Ward S. Mason, and Alexander W. McEachern, Explorations in Role Analysis (New York: John Wiley & Sons, 1958), pp. 11-18. ^Theodore Newcomb, Social Psychology (New York: The Dryden Press, 1951), p. 280. 5 Kingsley Davis, Human Society (New York: Macmillan, 1949), p. 90. 24

A major factor in the vagueness surrounding the use of role concept, according to Edgar Borgatta, is Ralph Ldnton's ambiguity, although the latter gave impetus to the use of the concepts of status and role. 6 Ldnton's classic definition is the point of departure for many authors who have attempted to define role: "A status, as distinct from the individual who may occupy it, is simply a collection of rights and duties. . . . A role represents the dynamic aspect of a status. . . . When he, the individual, puts the rights and duties which constitute the status into effect, he is performing a role. "7 Despite LintonTs attempt to distinguish the two notions of status and role, there appears to be a certain haziness inherent in the definitions. Borgatta draws attention to Linton's statement that status and role are "models for organizing the attitudes and behavior of the individual so that these will be congruous with those of the other individuals participating in the expression of the ideal patterns". 8 The model, being the system of normative prescriptions, would apply to the inclusive social situation, and the emphasis on the identification of a role (a set of rights and duties) lies entirely in specifying the defining situation. In other words, the normative prescriptions operating for the inclusive social situation must be specified. In this sense, a meaningful study of role is implicitly a study of social systems—thereby making redundant the use of the concepts of status and role, each in its own distinctive way. However, roles are located in social settings of almost infinite variety, each with its unique configuration of standards, significant actions, and degrees of organization. With roles enmeshed in so many ways in the social settings of any social system, it is necessary to elaborate the context to make provision for roles to operate along a continuum reflecting the variations in the specification of roles, on the one hand, and 6

Edgar F. Borgatta, "Role and Reference Group Theory", in Leonard S. Kogan, ed. , Social Science Theory and Social Work Research (New York: National Association of Social Workers, 1960), pp. 16-27. ?Ralph Linton, The Study of Man (New York: D. AppletonCentury, 1936), pp. 113-114. 8 Ibid., p. 114. 25

the degree of consistency of role conformity, on the other. 9 The framework for the analysis of role, then, in addition to specifying more carefully each of the elements that is needed for an effective analysis of patterned behaviour, must also be able to cope with the flexibility inherent in so many social networks. One such context, the family, is used here to evolve a framework that draws upon many of the contributions that have been made to the development of role theory. By "social role", reference is made to the impact on a person^ behaviour of the more or less patterned expectations of other persons in his life space. The assumption here, of course, is that various parts played by family members are not only a function of the individual psychological dispositions of family members, but are intimately related to the fact that the family is an institution that has consequences for its members. The behaviours that sustain or disrupt a family can at least be partially evaluated independently of the psychological disposition of individual family members. In other words, it is maintained that family behaviour cannot be completely accounted for by aggregating individual psychological dispositions, and that the examination of families in terms of role relations will provide new information that may throw light on many issues that have been so far elusive or formulated in ways that did not fully explore their potential utility for diagnosis, treatment planning, and evaluation of treatment methods. A basic assumption to note here is that in every role relationship there is a set of identifiable (but not necessarily harmonious) expectations directing the behaviour between two or more actors with reference to a particular type of social situation. These expectations are supported variously by the normatively based sanctions applied by ego, alter, and others. ROLE EXPECTATIONS

Expectations refer to behavioural standards directed by significant individuals in the social field toward a particular role incumbent. In addition, there may be written prescriptions, ^William J. Goode, "A Theory of Role Strain", American Sociological Review, XXV (August 1960), 483-495. 26

organizational regulations, etc., that encompass the total set of expectations that are relevant for the particular position. Where the family is the focus of analysis, from the point of view of a treatment-oriented program the significant focus for expectations may be found within the family itself. It is recognized that individuals within the family system may communicate legal norms and culturally stable patterns of expectations; yet within the system, when the individual becomes the primary medium of communication, the requisite information may be derived from family members themselves. Other structures, such as the extended kinship system, neighbourhood, and religious organizations, may affect the family, but these are not considered here, in order that we may deal solely with the nuclear family. In this connection it may be noted that the nuclear family does not account for all of the behaviour, but that the family system itself, as with any institution, can be viewed as a partially isolated system for analytical purposes. Expectations fall into two categories:10 (1) the actual standards directed at the ego by the alters, and (2) the perceived expectations of the ego. Although a fair degree of co-variation may be expected between actual and perceived norms, one of the more significant problems from the viewpoint of understanding family dynamics is the various forms of discrepancy that may exist between these two kinds of expectations. The concept of expectations cannot be restricted to verbal acts of communication that occur within the family. An individual may state clearly that he has a certain expectation of someone else; however, he may act in a way contrary to the norms sent by him to the other person. Besides actual communication of expectations and ego's own behaviour, there are other relevant axes that can be isolated. A possible source of discrepancy may be found in an individual1 s observations of the degree of conformity to the norms sent by him to the other. Such observed behaviours that fail to conform to the individual's wishes may create difficulties for the on-going behaviour of the individual and of the family. !OH. A. Murray, "Drive, Time, Strategy, Measurement and Our Way of Life", in Gardner Lindzey, ed., Assessment of Human Motives (New York: Grove Press, 1960). 27

Further, an individual may perceive accurately certain standards of conduct being directed at him by the other insofar as there is agreement between the norm sender and the norm receiver. However, in many cases there may be difficulty in accepting a sent norm, because of its disparity with the incumbent's own beliefs within a particular area of behaviour. These beliefs or self-standards of an individual, though to some extent determined by the norms directed at him, in fact stem from a source antecedent to the current situation or even external to the family environment itself. Thus, when two individuals hail from different ethnic groups or different social environments they may find that they hold different perceptions and standards from each other. On the level of self-standards, this discrepancy may not be directly communicated in the form of prescriptions or standards counter to another. If these selfstandards can be identified, it will be possible to assess potential sources of difficulty within the family itself. THE PROBLEM OF SANCTIONS

As soon as the concept of roles is introduced, one of the most frequent concerns is with the problem of sanctions. In the early discussions of folkways and mores by William Sumner and Albert Keller, H it was noted that the individuals who failed to comply would be subjected to punitive measures. The concept of sanctions has been, since that time, of perennial concern. In subsequent developments it was noted that sanctions may be either positive or negative; that is, the agents of control may wield the whip or hold out the carrot. Since even this formulation is somewhat too mechanical to account for role conformity, further refinements have introduced the notion of socialization, whereby individuals, prepared for certain roles, have internalized certain essential values, so that failure to conform arouses guilt and anxiety. A brief assessment of this very cursory review of developments in the concept of sanctions indicates that the concept is more complex than the mere notion that those who prescribe HWilliam E. Sumner, and Albert C. Keller, The Science of Society (New Haven: Yale University Press, 1927). 28

standards are in a position to punish or reward recalcitrant role performers. In fact, it is the rare role situation where the norm senders have, in the ordinary run of behaviour, such power at their disposal. The concept of order in society requires infinitely more subtle formulations than the traditional concept of sanctions. In the brief historical sketch of the concept, it is clear that, on one hand, there is reference to the way norm senders sometimes can control access to rewards on the part of the recipients; but, on the other hand, there is the introduction of rather complex assumptions about socialization and values and the resulting likelihood of the individuals to conform to certain segments of the social space. The problem is really the problem of conformity conceived most generally, a theme that cannot be fully treated in this report. The problem of conformity requires an analysis of the nature of social situations, the kinds of acts or behaviours under analysis, and the individuals own commitments to the particular segment of behaviour. Only in this way can the problem of conformity be dealt with satisfactorily, since all behaviour consists of actors with personal predispositions interacting in a social field. In the case of the family, one can presume that failures to conform to expectations will introduce the appropriate sentiments that bear on problems of conformity. It is also clear that what has come to be defined as positive sanctions in the form of affection are present in these situations, as well as the threat of withdrawal of affection. All of this bears on a full analysis of the situation; however, any research effort must demarcate boundaries within which it operates. In this case, where the family system is under analysis, and the behaviours under review are those that operate primarily in the confines of the family, one can make the assumption that both positive and negative sanctions are available to introduce compliance, as well as the mechanisms of socialization to introduce the personal orientations that facilitate conformity. That this is not uniformly true is clear; nor is it necessary to assume it is uniformly distributed. Any investigation must be a truncated segment of the total configuration. In this instance, the patterning of expectations and behaviour and values provides a complex and meaningful configuration insofar as this tells us how the family system and its integration throw some light on the issues 29

selected for study. The problem of conformity can be introduced at the appropriate time in order to extend the framework, although it should be noted that certain problems that bear on this theme can be investigated within the current framework. PARADIGM FOR THE MEASUREMENT OF ROLE The problem of measurement of role revolves around the development of suitable data-gathering techniques that conform to the definition of role as expectations of other persons within the system. The role paradigm is based principally on multiple levels of role congruence/incongruence in family interrelationships,, Briefly, the aim of the paradigml2 for the measurement of role is to make role-based concepts operational in a manner that will facilitate description of types of information needed to describe any role. For the purpose of the present research we adopt the generally accepted definition of role as referring to some organized or patterned behaviour that is prescribed by persons (or institutionalized agents) external to the incumbent. In performing this behaviour (B), an individual must perceive behavioural standards (P); however, he may not subscribe to them (S); further, to obtain a full description of role we must learn what he prescribes for other family members (N); and the extent to which he observes conformity to his prescriptions (O). Thus the paradigm distinguishes five different levels of role description and analysis, viz. : Self-standards (S) Reported behaviour (B) Perceived norms (P) Sent norms (N) Observed behaviour (O) These five levels of information are so designed that they can be obtained from each individual. They are all potentially 12For a detailed discussion, see Irving F. Lukoff, op. cit. See also Gerson David, "Toward a Systematization of Role Concepts: A Research Framework", paper delivered at the 1965 Annual Meeting of the National Council on Family Relations, Toronto. (Mimeographed.) 30

distinctive areas which, when combined and contrasted, isolate various individual roles or family role patterns. It is to be noted that the information sought does not refer to "bits" of behaviour« In role theory most discussions refer to bits of behaviour, and it can readily be seen that it is possible to identify innumerable such bits that govern all kinds of role relationships in which actors can get involved. The trend towards salvaging role theory from excessive specifications has been well illustrated in Neal Gross et al. 13 However, it is first necessary to avoid the imprecision of the more holistic formulations and to exploit the advantage of concentrating on more compact behaviour segments that are more easily documented empirically. A NOTE ON DISSONANCE Taking a cue from Leon Festingerfs theory of dissonance, 14 which makes a basic assumption that people prefer consistency among their cognitions and that they will initiate change in order to preserve their consistency, we may say that an explicit assumption underlying the construction of various measures based on the paradigm is that many kinds of discrepancy provide the basis for identifying various problem areas in roles and in the family system. For example, family systems may be organized around various norms which depend on their differing social and cultural milieu. This by itself does not lead to problems on the intra-familial level, though there might occur conflict situations with the external structure, such as an immigrant family!s adjustment problems to the demands of the main stream of society. The thesis developed here is that when a family shows discrepant norms between norm sender and norm receiver, family problems arise. Thus, when husband and wife hold different norms around division of labour in family activities, conflicts may arise. If the norm sender observes a lack of conformity to his norms on the part of the recipient, this, it is assumed, creates a source of difficulty. It is not the kind of norm, but the lack of consistency within various norms between family

13Qp. cit., p. 324. Leon Festinger, A Theory of Cognitive Dissonance (Evanston, 111.: Row, Peterson, 1957). 14

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members, that is the focus for identification of problem areas in role relationship. INDEX CONSTRUCTION

By means of the paradigm a number of measures can be constructed which will have special relevance for diagnosis and assessment of significant problems within the family. Such measures provide information which corresponds more directly with the theoretical assumptions that undergird family-centred treatment than do the usual personality scales that focus more directly on individual traits. These measures fall into two general classes: Intra-individual Role Measures These refer to descriptions of the individual in terms of the various levels that derive from instruments that he himself fills out. For example, we can look at an individual in terms of the norms he perceives being directed at him, as contrasted with his self standards /See-Peo/. 15 Insofar as these perceived norms and his self-standards are congruent, it is assumed that there is no basis, at least on this level, for any discrepancy that may be?a source of problems for him or the family. Other indices (self-based) like conformity to perceived standards /Bee-Peo/ and self-consistency /See-Bee/ can be constructed. Inter-individual System Measures These refer to various measures that assemble information across persons, and fall into two categories: Social role measures Implicit in the concept of social role is the influence of the field on the individual as a fundamental feature for defining behaviour. With information collected on the basis of the role 15

In these indices t!e!t stands for ego, and "o" for other. For example, /See-Peo/ means the difference between egofs report of his own self-standards and his perception of the norms directed at him by the other. In all indices the first subscript is the source and the second subscript is the direction of the norm. 32

paradigm we can compare, for example, the sent norms of the husband with the perceived norms of the wife. Insofar as she perceives the husband's norms more or less accurately, no difficulty arises for their relationship, although there may be some problems on other levels. Thus individuals can be described in terms of information collected from other persons as well as from themselves. The measure can be generalized so as to include more than one person focusing on an individual. For example, one can look at the oldest child in the family and his relationship with both the parents in order to ascertain whether norms in a particular area of behaviour sent by both of the parents are congruent with each other or whether they are discrepant. This is an operational equivalent of the role set concept of Robert Merton. 16 Family system measures These specify the degree of discrepancy in terms of the family as a system rather than any individual or dyad within the family. As an example of a family measure based on one of the five levels of the paradigm we may illustrate thus: if there are four family members, the various norms they prescribe for each other (12 in number) can be measured by an index of variability, i. e., a simple deviation index from the average score, on a particular level. If the index is high, it would indicate a large discrepancy; where the index is low, it would indicate a rather large degree of congruence in the family. When the family members are contrasted with each other, it is possible to describe the sent norms in terms of the average discrepancy that pervades the family. It is possible to describe family properties in terms of two or more levels of the paradigm. As an illustration, we may look at the extent to which communications are more or less accurately perceived within the family. This may be done by contrasting the norms which each individual sends to every other individual in the family with the perception by the latter. Thus the discrepancies can be summated for each dyad within the family system. In the case of a family with three members, 16Robert K. Merton, Social Theory and Social Structure (rev. and enl. ed. ; Glencoe, 111.: The Free Press, 1957), pp. 368-384. 33

we can compare husband with wife, or wife with husband, father with child, child with father, mother with child, and child with mother* The average role discrepancies provide us with an overall measure of the communication discrepancy in this particular segment for the entire family. The measures described above can be used as part of the diagnostic assessment at the intake of a case. They provide a description of potential sources of difficulty for the individual, viewed as an incumbent of a role, and the family as a system. If the role instruments are administered at intake and at termination, it is possible to measure the changes in each of the indices in the course of treatment, as affecting individual role or any combination of roles of family members, provided the measures are reliable and proper controls have been instituted. ROLE INSTRUMENTATION

The five levels of behaviour specified above provide a framework within which various kinds of instrumentation and observation can be developed. However, it would be difficult to ensure similar areas of behaviour in spontaneous observational situations.' The focus of treatment in one family may be on the problem teen-ager; in another the focus may be on the marital relationship between the spouses. Further, tHe levels that primarily pertain to the area of private attitudes would be difficult to fathom in short observational situations. For this reason, sets of instruments that utilize the paradigm described above and seek material directly from the individuals on beliefs, feelings, behaviour, etc. were developed by The Allegheny Family Study Project and have been put to test in the Toronto Project for the first time on a reasonably adequate sample. In role theory it is frequently assumed that there are specific norms that govern most areas of behaviour. While this might be true for large segments of behaviour in the case of highly organized contexts where there is a great deal of visibility, as in military or ecclesiastical hierarchies, in the case of the family, despite its long history, tradition, and legal norms and customs, only very few areas of behaviour can be identified where this is likely to be true. The variability of family patterns 34

can be documented by class and ethnic groups, and within relatively homogeneous groups it is possible to make modest predictions about such specific areas as child rearing, the division of labour within the family, or the pattern of activities in which the family engages,, But those areas encompass only a small part of the behaviour of the family, and family norms are likely to be widely distributed, since in the urban family system in North America behaviour is less visible, thus resulting in greater freedom for the display of various kinds of innovations., In order to develop a measuring instrument that can be used to identify family norms, the instrumentation should permit some variability within individuals, who may be classified into relatively homogeneous categories. Thus, for example, the manifest items in the instrument may only be shared partly by the husband and wife, yet there may not be any real discordance between them in a particular sector. Individuals are classified on the basis of a series of multi-item scales where different combinations of responses may yield the same score. Contrasts within individuals, then, tend to be conservative in that they do not capitalize on every disagreement that may exist. The assumption here is that individuals who, within a particular dimension, generally subscribe to approximately the same number of items, will have more or less the same general score, thereby ensuring sufficient homogeniety. The instrument also enables the classification of persons on as many pieces of information as it is possible'to include. DIMENSIONS OF BEHAVIOUR

In selecting the dimensions of behaviour, the primary consideration was to select those that are significantly applicable for most families, and around which a large number, if not all of the families, are organized. Further, it was necessary to identify sectors of behaviour applicable to persons placed in different conditions of life marked by variability in educational and occupational attainments and cultural situations. This precluded the incorporation into the instruments of some behaviour that may be dominant within a particular family. As indicated earlier the four major activity areas selected for the instrumentation were (1) household tasks; (2) affection; 35

(3) child rearing; and (4) task assignment. Household Tasks This section of the questionnaire includes 11 items designed to form a measure that reflects at one extreme a meticulously organized orientation, and at the other end, an unconcerned, disorderly orientation. Each item is repeated in five versions following the five different levels of role analysis specified above. The response patterns are phrased in such a way as to be relevant to all members. Affection From the 19 items included in the questionnaire, two more or less distinct areas were carved out, viz., (1) sexual, and (2) affectional communication. Response patterns in this dimension apply only to husband and wife. Child Rearing There are 19 items in the questionnaire on child rearing, some of which apply only to adults and some only to children. These have been phrased in an appropriate manner to tap the responses from the family member concerned in each of the five levels. It was expected here that there would be two separate dimensions: (1) one related to child control techniques, and (2) the other concerned with the degree of child centredness. The first dimension was expected to contain such items as would reflect a measure of control in a leniency-severity continuum. The second dimension would include such items as those reflecting the degree to which the family activities and decisions involve the childrenTs taking an active part. Task Assignment There are 34 items of family activities in which the respondent indicates who takes care of things and makes various decisions, who the respondent would like to see do this, and finally what each spouse/child perceives the other spouse/parent would like.

36

INSTRUMENTS

The instruments developed for use in connection with the framework described above envisage the collection five times of information relative to the five different levels. In only one dimension, affection, a sixth level, viz. , evaluation level (E), was added. Where the family respondents comprised more than two individuals, separate assessments were made of the Sent Norms (N), Perceived Norms (P), and Observed Behaviour (O) for each additional family member. The same items were reviewed on each level, though changes were made in the phrasing of response categories relative to the items in order to focus attention on the nature of the particular level of behaviour being examined. The response patterns included in the sample items are those from the main study version of the Toronto Family Diagnosis instruments. For example: Household Tasks Self- standards (S) Having the house very clean at all times

Reported behaviour (B) Having the house very clean at all times. What do you do about it?

Much more important to me than to most people Somewhat more important About average Somewhat less important Much less important I do what I can very frequently I do what I can sometimes I do what I can only occasionally I do little or nothing I avoid doing anything about it

Perceived Norms (P) As far as having a clean Expects me to help house is concerned a great deal my Expects me to help fairly often

37

Sent Norms (N) As for having the house very clean at all times, I expect mv

Observed Behaviour (O) As for having the house clean at all times, my

Expects me to help occasionally Does not expect me to help much Doesn't want me to help To do everything possible To do what reasonably can be done To be relaxed about it I don't care To do nothing about it Sees to it all the time Sees to it fairly often Sees to it occasionally Sees to it only rarely Never sees to it

Supplementing the information sought around the role paradigm, a form requesting information on social background and demographic data on the family members was included. Such variables as education, occupation, income, religious preference, and ethnic group were studied. RELIABILITY AND VALIDITY The Toronto Project offered the first opportunity to adapt the framework to an adequate sample of families. The 123 38

families included in the research sample were sufficient to permit studies in scalability. As with any set of measurements, it is necessary to ascertain the extent to which the measures are reasonably stable and also to determine the extent to which they measure reasonably well the things they hope to identify. These instruments were pre-tested during the summer of 1962 on a sample of 13 cases provided by the research agency— the Family Service Association of Metropolitan Toronto. After the main study got under way and first administrations were secured from 100 families, item analysis was carried out by use of indices of discrimination between upper and lower quartiles of the distributions. The results of the item analysis showed significant item-total correlations, and only two items out of a total of 49 items in the three different content areas (household tasks, affection, and child rearing,) had to be eliminated. These results are contained in Appendix I. Following item analysis, split-half reliabilities were computed for all the scales in the three dimensions. These are shown in Appendix n. Though the item analysis for all the scales showed high item-total correlation, the reliability coefficients for the scales in the child rearing dimension were low. We therefore computed item inter-correlations for the scales in the child rearing dimension for all the five levels. These are presented in Appendix HE. On the basis of the generally accepted yardstick among statisticians that a relationship is not due to chance if _r is at least three times the standard error of j:, we accepted . 2 as an acceptable correlation coefficient for a N^ of 230 in the case of adults. At least. 4 is necessary for a significant correlation for a N of 50 in the case of siblings. On the basis, however, that if the siblings 1* is increased, the reliability of £ is increased, we concluded that . 2 may be acceptable as the yardstick for both adults and siblings. An examination of the individual levels both for adult control and sibling control suggested that we form two subscales, viz., affectional control scale with three items, and physical control scale with four items. The results of the chi-square test that we applied to these two subscales to determine the significance of the differences in proportions, viz., the upper and lower half of total score when related to individual item responses, yielded significant chi-squares. (See Appendix IV.) 39

In the case of child centredness scales we eliminated two items on the basis of the computed item inter-correlations and worked with a final scale of eight items, as shown in Appendix V. Other methodological problems that were dealt with are discussed below: Independence of Levels on Straight Standard Scores To test the independence of levels, with reference to respondents1 consistency in subscribing to the multi-item scales, we carried out statistical analysis by computing inter-level correlations within each of the content areas (see Appendix VI). The average of coefficients of correlation in each of the scales for husbands and wives is shown separately as follows: Husband Wife Household Tasks .34 .24 Affection/Sex .49 .51 Affection/Communication .41 .38 Child Rearing/Physical Control .40 .42 Child Rearing/Affection Control .55 .45 Child Rearing/Child Centredness .63 .48 It appears that the five levels are realistically perceived as significantly different, and as the statistical analysis shows above, we can conclude that generally the levels are independent with some variation among husbands and wives in certain content areas. Independence of Levels on the Variance Index The variance index was selected to determine whether the different levels were sufficiently independent of each other to warrant their retention. Correlation coefficients were carried out in respect of the index on the five different levels within each content area and across content areas. The results are given in Appendix Vn and Appendix Vm. The general conclusion that can be drawn from these results is that the indices are sufficiently independent of each other. Instrument Scores and Caseworker Rating Evaluations For the subsample for which caseworker rating schedules for first administration were available we carried out a study to determine to what extent the caseworker rating score is as40

sociated with the instrument score on the corresponding scales for which information was obtained As anticipated, the results noted in Appendix IX confirm the low degree of association between rating and individual instrument scores in respect of individual level scores and selected role discrepancy indices. Caseworker Rating Schedule-winter-cor relations The caseworker's rating in each of the separate area evaluations in household tasks, child rearing, and affection was correlated with global evaluation. With the exception of money items and the marital relationship sexual items, the correlations in Appendix X indicate that the global evaluation which was made as a separate judgment is substantially related to the separate area evaluations. Statistical Significance The exploratory nature of the investigation, together with the small numbers in subgroups, and also the lack of randomness of the treatment sample, precluded the application of any tests of statistical significance. The fact that most findings were based on large sets of tables, to some extent reduced the degree of chance.

41

Ill THE PROJECT FAMILIES

A total of 123 families agreed to participate in the research program. Of these, 40 percent were self-referred or former clients. The next three categories of referral source, accounting for 34 percent of the families, were the health agencies, public welfare agencies, and the Family Court. The lowest number of referrals came from the clergy and the school system. Probably, the clergy are less accustomed than physicians or psychiatrists to refer clients to social agencies, and the school system in the Metropolitan Toronto area has just begun to establish school social work departments. Table 3:01* gives the data on referral sources. NUMBER AND AGE RANGE OF CHILDREN

Of the families in the sample, 86 had one to three children. There were only 8 families with no children, and 3 with as many as eight children. Barring the one case of a thirty-two-yearold living at home, the ages of the children ranged from less than one year to twenty-one years. Table 3:02 shows the number and age range of the children living at home, children less than one year of age being listed as one-year old. SOCIAL CLASS OF FAMILIES By means of the "Two Factor Index of Social Position" developed by August Hollingshead, 2 which is based on occupation 1

Throughout the text the tables are numbered consecutively within sections. Thus, Table 3:01 refers to the first table in Section IE. 2 August B. Hollingshead, "Two Factor Index of Social Position" (1965 Yale Station, New Haven, Conn., 1957). (Mimeographed. ) 42

TABLE 3:01 SOURCES OF REFERRAL OF FAMILIES Source Self-referred or former clients Public Welfare services Health services Family Court Publicity, telephone book, newspaper, radio Friends, neighbours, relatives, or other clients Private social agencies (Community Chest, Red Cross, etc.) Clergymen School Unknown TOTAL

Number

Percentage

47 17 14 11

40 14 11 9

10

8

9

7

4 3 3 5

3 2 2 4

123

100

TABLE 3:02 NUMBER AND AGE RANGE OF CHILDREN Number of Children

Age Range

Number of Families

0 1 2 3 4 5 6 7 8

„ 1-17 1-21 1-18 1-19 1-18 1-14 1-17 1-32

8 24 41 21 12 6 3 5 3

TOTAL

123

43

and education of the head of the household, the 123 families were classified as follows: Number of Families Social Position 1 Class I 10 Class II 11 Class in 50 Class IV Class V il TOTAL 123 Among 31 of the families in Class V, some had annual incomes of over $3,600 and less than $9,600. Some method had to be devised to distinguish the highest and lowest income in the group. As Hollingshead's index does not take note of income variable, the only alternative was to divide Hollingshead's Class V into two classes on the basis of total score, on the rationale that the higher scorers in the category would reflect higher occupation and education, thereby indicating higher earning capacity. The Rollings head's total score of 61-77 for Class V was therefore divided into two categories, viz., 61-68 for Va and 69-77 for Vb. Va category numbered 31 and Vb numbered 20. The resulting skewed distribution required the collapse of the table; for the final social class categories we chose to work with three classes, viz., the upper middle class embracing HollingsheadTs Classes I, II, and HI; the lower middle class embracing Hollingshead's Class IV and the dichotomized Class Va; and the lower class embracing the dichotomized Class Vb. According to this reworked classification, the clientele in the research sample was predominantly lower middle class grouped as follows: Upper Middle Class 22 Lower Middle Class 81 Lower Class 12 TOTAL 123 EDUCATIONAL BACKGROUND OF SPOUSES Table 3:03 shows that 27 percent of the husbands and 30 percent of the wives had Grade 12, or higher education, while 66 percent of the husbands and 65 percent of the wives had education from Grades 7 to 11. It is interesting to note that there 44

TABLE 3:03 EDUCATIONAL ATTAINMENT OF SPOUSES Education

(123 families) Husband % 2

Grade 1-4 5-6 7-9

5 34 32 10 11

10-11 12

13-15 16 (College Graduate) Graduate Professional No Answer

4 2

—

TOTAL

100

Wife % 1

3 41 24 19 9 2

1 100

are nearly twice as many wives as husbands with Grade 12 education. OCCUPATION OF HEAD OF HOUSEHOLD

Table 3:04 shows that 20 percent of the husbands were in professional, managerial, or administrative categories, and an equal percentage of the men was found in two other categories, viz., clerical and sales workers and technicians, and skilled workers. BIRTHPLACE OF SPOUSES Table 3:05 shows that 80 percent of the wives and 75 percent of the husbands in the treatment sample were Canadian-born. According to the Census Report for Metropolitan Toronto, 48 percent male and 52 percent female of the population are in the age group twenty years and over (marital age group). This means that Canadian-born are over-represented in the treatment 45

TABLE 3:04 OCCUPATIONAL DISTRIBUTION OF HUSBANDS

(123 families) Occupation

Percent

Higher Executive Personnel Business Managers, Proprietors Administration Personnel Clerical and Sales Workers and Technicians Skilled Manual Machine Operators and Semi-skilled Unskilled

2 8 10 20 20 31 9

TOTAL

100

TABLE 3:05 BIRTHPLACE OF SPOUSES COMPARED WITH GENERAL POPULATION

Country

(percent) Treatment Sample

Female* Male* (H 199, 409) (N 202, 243)

Husband