Rating Each Dimension
At the conclusion of the session, the judge should make ratings for each of the four dimensions for each family member in the blank spaces provided. The anchors (not at all, moderately, very much) refer both to the frequency of the behavior and its meaningfulness or significance in the session. With the exception of the Sense of Purpose dimension, there are four columns of blank lines next to each indicator, one for each of 4 family members. (The investigator labels these columns for each family member.) At the end of each section is a 7-point, Likert scale, with anchors -3 (not at all), 0 (moderately), and +3 (very much ); blank spaces are used for the final ratings. (Note that only one space is provided for the Shared Sense of Purpose dimension, since only one rating is made for the family as a whole.)
As discussed earlier, the individual items are assumed to be behavioral indicators of the more global, underlying dimensions, which are defined in more subjective terms (i.e., in terms of the clients’ cognitions and affect). Judges need to use the check marks they made on the individual items to make their overall ratings rather than rely simply on an intuitive sense about each dimension.
In developing the instrument, we realized that it is impossible for a judge not to make comparisons of the strength of the alliance across family members while watching the videotape and making ratings. Thus, the rating of each family member can be influenced by how the judge rates other family members. For this reason, we created the following guideline: The judge should first look at the check marks and decide who in the family is the least involved, connected. This person should be rated first, followed by the family member who is the next least involved, and so forth. In this way, the most involved or committed family member is rated last.
To facilitate the process of going from the check marks to the ratings, judges should use the following guidelines for the Engagement, Safety, and Emotional Connection dimensions :
If no checks are made in a given dimension, the score should be 0. This means that the client is viewed as at least moderately aligned (otherwise, he or she would be protesting the therapy or would leave the room). In family therapy, it sometimes occurs that a client does not speak during a given session, particularly if there are many people in the room. If there are no negative or positive indicators and the client does not speak, the rating should be 0.
If only negative items are checked, the score must be less than 0. Rate the client as -3 only if it’s clear that the person is antagonistic to the therapy and demonstrates that antagonism behaviorally -- otherwise the score would be a -2 or -1 depending on a decision about how negative the behaviors seem to the judge.
If only positive items are checked, the score must be above 0.
If the only positive item is nonverbal (open upper body posture, eye contact, mirrored body language), the rating should be +1.
A +3 is given only if it’s clear that the client is highly invested in the therapy, as demonstrated by showing a great deal of vulnerability (Safety) or taking a very active part in the therapeutic process (Engagement) or there is clear, important caring demonstrated toward the therapist (Emotional Connection). Otherwise, the score should be a +1 or +2 depending on how positive you judge the behaviors to be. If the client is crying from the heart, for example, the score would probably be a +2.
If there are both positive and negative items checked, the judgment should be either -1, 0, or +1 depending on an assessment of the balance in frequency or meaningfulness of the checked behaviors.
The judges’ task is, nonetheless, somewhat subjective. Some behaviors, particularly the nonverbal ones, can occur throughout the session (e.g., “Family members mirror each other’s body posture”), whereas most of the other behaviors are likely to occur once or a few times. Here is where the judge needs to decide on the significance, or clinical meaningfulness of the behavior. If, for example, a family member “agrees to do homework assignments” once and with minimal enthusiasm, the rating might be +1. If the family member asks for details about the assignment and talks about when, how, and under what circumstances it will be done, the rating might be +2. If the family member is particularly enthusiastic and committed to the assignment, the rating might be +3.
As another example, consider the item, “Client refuses or is reluctant to respond to the therapist.” If this occurs once or minimally, the rating would be -1. If the client spends a fair amount of the session refusing to speak, the rating could be -2. If the session is entirely spent this way, the rating would be -3.
For Shared Sense of Purpose, one rating is given for the entire family. The judges should be aware that this dimension refers to a shared sense of purpose about the therapy, not about the family in general or the presenting problem. In other words, a couple might enjoy each other’s company a great deal yet have very different views on the value of therapy for improving their relationship. Alternately, everyone in the family might agree that Bobby has a problem; this agreement reflects a shared sense about what the problem is, but not necessarily a shared sense of purpose with respect to the therapy. The parents, for example, might indicate that the focus of therapy should be Bobby’s misbehavior, but Bobby might state that the therapy is a complete waste of time or that he thinks the therapist should focus on his parents’ strictness and his father’s alcoholism. In this case, the sense of unity within the family with respect to the therapy is not optimal.
Judges should use the following guidelines to go from the behavioral ratings to the overall rating for Shared Sense of Purpose:
Judges first need to see how many family members have positive and negative items checked.
If there are no items checked for any family member, the rating should be 0. As with the other ratings, the assumption is that there is at least a moderate sense of purpose within the family if everyone is there and is not showing any behavior indicative of a poor alliance.
If there is at least one positive item and no negative items checked for every family member, the rating should be at least +1, and could be +2 or +3, depending on the judgement of the number and meaningfulness of the items checked.
If there is at least one negative item for any family member, the rating should be -1 or -2, depending on the judgement of just how negative the behavior is in the session.
If two or more family members have negative items checked, the rating should be -3 or -2.
If there are both positive and negative items checked, the judgment should be either -1, 0, or +1 depending on an assessment of the balance in frequency or meaningfulness of the checked behaviors.
If there is a major disagreement between family members expressed in the session about the value of therapy or what is going to be accomplished there, the rating should be -3, even if no other negative items are checked.