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Interaction in Families With a Schizophrenic Child

Interaction in Families With a Schizophrenic Child Abstract Table of Contents Section I Part A—Objectives 1. To develop a quantitative methodology 2. To compare family interaction patterns 3. To explore tentative hypotheses about the meaning of differencesPart B—Procedure 1. The "schizophrenic" families 2. The "control" families 3. Instruction 4. Data processingSection II Methodological limitations of this approach Methodological problems 1. The issue of stability and change in family interaction patterns 2. What is a sample of family process? 3. Can one sample "schizophrenic" families? 4. Specificity of patterns 5. Diagnosis of schizophrenia 6. Effect of study context on "natural" family interaction 7. Can "significant" variables be measured? Section III Part A—The family as a communication system Part B—The family as a regulation and control system Part C—The family as a socialization system Part D—Questions and controlReferences AppendixSection IPart A. Objectives.—This paper is a report on one of a series References 1. J. N. Morris writes, "`... the epidemiologist... can sometimes ask questions which the clinician also asks, and get different (maybe better, maybe worse) information in reply. Often, the epidemiologist may ask questions that cannot be asked in clinical medicine at all." 30 2. Rather than repeat the phrase "families with a child diagnosed as schizophrenic," we shall use the briefer expression, "schizophrenic families," throughout the paper. This does not imply that other family members have been diagnosed likewise. 3. Work done by Dr. Lennard with Dr. N. Ackerman in the Department of Psychiatry, Jewish Family Service, New York. 4. The significance of locating new variables worth pursuing is underlined in a slightly different context by Levinson, "It is often the aim in process studies to examine in a microscopic way what is going on ... with the aim of deriving variables for further study" (p 197).24 5. "The primary family members involved in the family conflict are the father, mother, and the patient." 9 6. The topics for discussion were: (1) Would you discuss whether or not a boy might have some duties to perform around the house and, if so, what they might be. (2) When a boy needs a helping hand with his homework, do you think it is better for mother or for father to help out? Would you discuss this and let me know your thoughts when I return in 15 minutes. (3) Here is a list of occupations that a boy might think of doing later in life (typed on card): fireman, teacher, reporter, dentist, pilot, and engineer. Would you discuss these occupations among yourselves and list, in order, the three you think best. I'll be back in 15 minutes to see what you've decided. 7. For more information about coding methodology, see Lennard and Bernstein.22 8. The study of family interaction patterns in schizophrenic families often has as its objective the identification of those patterns which support and maintain the illness of one of the family members or the characterization of one of the family members as "ill." For example, Bateson writes: "These families seem to be stable with relation to the descriptive statement 'this family contains a schizophrenic.' If the identified patients shows sudden improvement the behavior of the others will change in such a way as to push him back into schizophrenic behavior" (p 118).7 Another illustration of this position is the recent work of Dan Miller, which explores most skillfully the pressures operating in families to maintain the identified patient as "patient." Miller is working mainly with families with a child who has a serious reading disability.29 9. A number of investigators (for example, Bateson, Bowen, Goldfarb, Haley, Jackson, Lidz, and Wynne) have proposed that the mode of familial interaction is the significant factor (alone or in combination with genetic and other unspecified variables) which leads to the development of thinking and behavioral processes labeled as schizophrenic. For instance, Haley writes: "A logical hypothesis about the origin of schizophrenic behavior, when the behavior is seen in communications terms, would involve the family interaction of the patient. If a child learns to relate to people in a relationship with parents who constantly induce him to respond to incongruous messages, he might learn to work out his relationships with all people in those terms. It would seem to follow that the control of the definition of relationships would be a central problem in the origin of schizophrenia."17 10. N. W. Ackerman suggests that "the family environment in the 'sick' families may remain essentially unaltered through the years." In that case, he states, "the personality of the child is fixed by the time he reaches six years and thereafter changes very little ... but if the family environment itself changes considerably over the passage of years the ongoing interrelations. . .bring about considerable modification of the emerging personality of the child. . . ." 2 11. The work of Lyman Wynne and collaborators is very relevant here. Wynne's concept of pseudo-mutuality refers to expectational stability (or rigidity) in schizophrenic families. Wynne's work not only suggests stability of family processes in such families, but considers such stability as inappropriate and as symptomatic of the family disturbance itself.35 12. It should be noted that the same complex problems do not arise in exploring the hypothesis that current intrafamily patterns contribute towards maintaining the illness of a family member. 13. Students of paralinguistic and kinesic interaction such as R. Birdwhistle have claimed that characteristic patterns of such interaction are revealed within a few minutes or less (see for example: Pittenger32). 14. Unreliability in diagnosis of schizophrenia is estimated as quite high by Don Jackson.19 15. Seven of the children were diagnosed at the Kings County Child Guidance Clinic, two at the New York State Psychiatric Institute, and one at the Rockland State Mental Hospital. 16. One can also capitalize on the special situation created by the research by paying special attention to the reactions of family members to the recording and observation. In a still to be completed study on another group of schizophrenic families (the children of which are in a day treatment center) one of the mothers spent a few minutes looking for the location of the tape recorder in the room, only to remark to the son, some time later, that she was not at all "worried about being recorded." 17. "The performance of a small group depends upon the channels of communication open to its members...."30 18. Ordinarily, one would not equate strength of communicational bond with rate and volume of verbal communication only. However, one may be more justified in doing so when using data from a situation which requires all family members to communicate and to communicate with each other. 19. The reader is reminded that we are reporting here on a triad, involving the father, mother, and the identified patient, and that the parents may interact differently with other siblings. 20. We assume that this position is implied by Parsons and Bales a number of times. For example, in this statement: "We will see that particular importance attaches to four familial role types and the subsystems generated by their relations to each other. An important field of study would be that of the effect of absence of any of these many types . . ." (p 37).31 21. We are not implying that these definitions are unique to each family. In part, they derive from the families' group memberships. 22. The significance of viewing behavior as "initiation" or "response" is developed in a series of thoughtprovoking papers by Hilde Bruch (see Bruch, H.11). 23. The reader should not equate this very specific concept of intrusion with the "intrusiveness" attributed to parents of schizophrenic patients. This concept is approximated by our category of level II communication which is described in the third part of the Findings section of this paper. We imply no negative connotation to this notion of intrusion, ie, third person entry into two person interaction. 24. Based on data made available at the Department of Psychiatry of the Jewish Family Service (in collaboration with N. W. Ackerman) and on data made available by Frances Cheek. 25. It has been suggested that a child's rate of intrusion may be positively related to age. Therefore, differences in intrusion rates might be explained if the control children were older than the schizophrenic children. However, as indicated, below (mean and median ages given), the age distribution of the two groups of children is almost alike. 26. Further work is now in progress which categorizes types of intrusion statements made by family members. For example, we shall be able to tell whether intrusions are more likely to be questions, agreements, disagreements with position or with presentation of self, interpretations, etc. Types of responses to intrusion are also under investigation. For example, is it the father or mother who is less likely to permit and respond to intrusion? How, for example, do parents cope with intrusion of the nonpsychotic sibling? 27. In what sense this is understood by the child is an unresolved question and one which deserves attention in studies of infant-mother interaction. 28. In our discussion, we follow the issues of such students of child development as Bruch, Goldfarb, Settlage, etc. Their hypotheses sound reasonable and are relevant to the issues we are exploring. 29. Stanley Schachter suggests that any "normal bodily state will give rise to pressures to decide what is felt, to decide how these feelings are to be labeled."33 Following Schachter, we would postulate that this pressure would result in the soliciting and acceptance of parental interpretation of bodily states. 30. Parsons et al, p 116.31 31. Lennard, H. L., and Bernstein, A., p 183.22 32. In our view, socialization includes the labeling of inner states and their evaluation as appropriate or inappropriate, as desirable or undesirable. 33. Ackerman, N. W.: Family Focused Therapy of Schizophrenia , Jewish Family Service NY, 1959, mimeographed. 34. Ackerman, N. W.: Lectures at Academy of Medicine, March, 1960, unpublished data. 35. Bales, R. F.: Interaction Process Analysis: Method for Study of Small Groups , Cambridge, Mass: Addison Wesley Press, 1950. 36. Bales, R. F.: " Preface ," in Lennard, H. L., and Bernstein, A.: Anatomy of Psychotherapy , New York: Columbia University Press, 1960. 37. Bateson, G., et al: Toward Theory of Schizophrenia , Behav Sci 1:251-264 ( (Oct) ) 1956.Crossref 38. Bateson, G.: Personal Communication to the authors. 39. Bateson, G.: " Biosocial Integration of Behavior in Schizophrenic Family ," in Exploring Base for Family Therapy , N. W. Ackerman, et al, ed., New York: Family Service Association of America, 1961. 40. Bell, N.: Personal communication to the authors. 41. Bowen, M.: " Family Concept of Schizophrenia ," in Etiology of Schizophrenia , D. D. Jackson, ed., New York: Basic Books, Inc., Publishers, 1960. 42. Bowen, M.: in Family Relationships in Schizophrenia , A. Auerback, ed., New York: The Ronald Press Co., 1959. 43. Bruch, H.: Falsification of Bodily Needs and Body Concept in Schizophrenia , Arch Gen Psychiat 6:18-24 ( (Jan) ) 1962.Crossref 44. Epstein, N., and Westley, W.: Patterns of Intra-Familial Communication , Psychiat Res Rep 11:1, 1959. 45. Fleck, S.; Lidz, T.; and Cornelison, A.: Comparison of Parent-Child Relationships of Male and Female Schizophrenic Patients , Arch Gen Psychiat 8:1-7 ( (Jan) ) 1963.Crossref 46. Fleck, S., et al: Some Aspects of Communication in Families of Schizophrenic Patients, paper read before the American Psychiatric Association Meeting, Philadelphia, 1959. 47. Goldfarb, W., et al: " Parental Perplexity and Childhood Confusion ," in New Frontiers in Child Guidance , New York: International Universities Press, 1958. 48. Goldfarb, W.: Childhood Schizophrenia , Oxford: Harvard University Press for Commonwealth Fund, 1961. 49. Haley, J.: Interactional Description of Schizophrenia , Psychiatry 22:321-332 ( (Nov) ) 1953. 50. Haley, J.: Family Experiments: New Type of Experimentation , Family Process , vol 1, No. (2) , Sept, 1962. 51. Jackson, D. D.: " Critique of Literature on Genetics of Schizophrenia ," in Etiology of Schizophrenia , New York: Basic Books, Inc., Publishers, 1960. 52. Laing, D.: Self and Others , London: Tavistock Press, 1961. 53. Leavitt, H. J.: Some Effects of Certain Communication Patterns on Group Performance , J Abnorm Soc Psychol 46:38-50, 1951.Crossref 54. Lennard, H. L., Bernstein, A., et al: Anatomy of Psychotherapy , New York: Columbia University Press, 1960. 55. Lennard, H. L.: " Analysis of Family Conflict ," in Exploring Base for Family Therapy , N. W. Ackerman, et al, ed., New York: Family Service Association of America, 1961. 56. Levinson, D.: Research in Psychotherapy , H. H. Strupp and L. Luborsky, ed., Washington, DC: American Psychological Association, Inc., 1962. 57. Lidz, T., et al: Intrafamiliar Environment of Schizophrenia Patients: II. Marital Schism and Marital Skew , Amer J Psychiat 114:241-248, 1957. 58. Lidz, T., in Panel on Family Therapy , American Orthopsychiatric Association, Washington, DC, March, 1963. 59. Lidz, T., and Fleck, S.: " Schizophrenic Human Integration and Role of Family ," in Etiology of Schizophrenia , D. Jackson, ed., New York: Basic Books, Inc., Publishers, 1960. 60. Miller, D.: in Lecture to Sociology of Mental Health Seminar , Columbia University, New York, October, 1962. 61. Miller, G. A., and Heise, G. A.: Problem Solving by Small Groups Using Various Communication Nets , J Abnorm Soc Psychol 46:327-336, 1951. 62. Morris, J. N.: Uses of Epidemiology , Edinburgh, Scotland: E. & S. Livingstone, Ltd., 1957. 63. Parsons, T., and Bales, R. F.: Family, Socialization and Interaction Process , Glencoe, Ill: The Free Press, 1955, pp 91-94. 64. Pittenger, R. E., et al: First Five Minutes: Sample of Microscopic Interview Analysis , Ithaca, NY: Paul Martineau, 1960. 65. Schachter, S.: Interaction of Cognitive and Physiological Determinants of Emotional State, paper read before Symposium, Psychological Approaches to Human Behavior, Harvard Medical School, Cambridge, Mass, April 18-20, 1963. 66. Shands, H. C.: Thinking and Psychotherapy , Cambridge, Mass: Harvard University Press, 1960. 67. Wynne, L. C., et al: Pseudo-Mutuality in Family Relations of Schizophrenics , Psychiatry 21:205-220, 1958. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Interaction in Families With a Schizophrenic Child

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American Medical Association
Copyright
Copyright © 1965 American Medical Association. All Rights Reserved.
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0003-990X
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1598-3636
DOI
10.1001/archpsyc.1965.01720320054007
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Abstract

Abstract Table of Contents Section I Part A—Objectives 1. To develop a quantitative methodology 2. To compare family interaction patterns 3. To explore tentative hypotheses about the meaning of differencesPart B—Procedure 1. The "schizophrenic" families 2. The "control" families 3. Instruction 4. Data processingSection II Methodological limitations of this approach Methodological problems 1. The issue of stability and change in family interaction patterns 2. What is a sample of family process? 3. Can one sample "schizophrenic" families? 4. Specificity of patterns 5. Diagnosis of schizophrenia 6. Effect of study context on "natural" family interaction 7. Can "significant" variables be measured? Section III Part A—The family as a communication system Part B—The family as a regulation and control system Part C—The family as a socialization system Part D—Questions and controlReferences AppendixSection IPart A. Objectives.—This paper is a report on one of a series References 1. J. N. Morris writes, "`... the epidemiologist... can sometimes ask questions which the clinician also asks, and get different (maybe better, maybe worse) information in reply. Often, the epidemiologist may ask questions that cannot be asked in clinical medicine at all." 30 2. Rather than repeat the phrase "families with a child diagnosed as schizophrenic," we shall use the briefer expression, "schizophrenic families," throughout the paper. This does not imply that other family members have been diagnosed likewise. 3. Work done by Dr. Lennard with Dr. N. Ackerman in the Department of Psychiatry, Jewish Family Service, New York. 4. The significance of locating new variables worth pursuing is underlined in a slightly different context by Levinson, "It is often the aim in process studies to examine in a microscopic way what is going on ... with the aim of deriving variables for further study" (p 197).24 5. "The primary family members involved in the family conflict are the father, mother, and the patient." 9 6. The topics for discussion were: (1) Would you discuss whether or not a boy might have some duties to perform around the house and, if so, what they might be. (2) When a boy needs a helping hand with his homework, do you think it is better for mother or for father to help out? Would you discuss this and let me know your thoughts when I return in 15 minutes. (3) Here is a list of occupations that a boy might think of doing later in life (typed on card): fireman, teacher, reporter, dentist, pilot, and engineer. Would you discuss these occupations among yourselves and list, in order, the three you think best. I'll be back in 15 minutes to see what you've decided. 7. For more information about coding methodology, see Lennard and Bernstein.22 8. The study of family interaction patterns in schizophrenic families often has as its objective the identification of those patterns which support and maintain the illness of one of the family members or the characterization of one of the family members as "ill." For example, Bateson writes: "These families seem to be stable with relation to the descriptive statement 'this family contains a schizophrenic.' If the identified patients shows sudden improvement the behavior of the others will change in such a way as to push him back into schizophrenic behavior" (p 118).7 Another illustration of this position is the recent work of Dan Miller, which explores most skillfully the pressures operating in families to maintain the identified patient as "patient." Miller is working mainly with families with a child who has a serious reading disability.29 9. A number of investigators (for example, Bateson, Bowen, Goldfarb, Haley, Jackson, Lidz, and Wynne) have proposed that the mode of familial interaction is the significant factor (alone or in combination with genetic and other unspecified variables) which leads to the development of thinking and behavioral processes labeled as schizophrenic. For instance, Haley writes: "A logical hypothesis about the origin of schizophrenic behavior, when the behavior is seen in communications terms, would involve the family interaction of the patient. If a child learns to relate to people in a relationship with parents who constantly induce him to respond to incongruous messages, he might learn to work out his relationships with all people in those terms. It would seem to follow that the control of the definition of relationships would be a central problem in the origin of schizophrenia."17 10. N. W. Ackerman suggests that "the family environment in the 'sick' families may remain essentially unaltered through the years." In that case, he states, "the personality of the child is fixed by the time he reaches six years and thereafter changes very little ... but if the family environment itself changes considerably over the passage of years the ongoing interrelations. . .bring about considerable modification of the emerging personality of the child. . . ." 2 11. The work of Lyman Wynne and collaborators is very relevant here. Wynne's concept of pseudo-mutuality refers to expectational stability (or rigidity) in schizophrenic families. Wynne's work not only suggests stability of family processes in such families, but considers such stability as inappropriate and as symptomatic of the family disturbance itself.35 12. It should be noted that the same complex problems do not arise in exploring the hypothesis that current intrafamily patterns contribute towards maintaining the illness of a family member. 13. Students of paralinguistic and kinesic interaction such as R. Birdwhistle have claimed that characteristic patterns of such interaction are revealed within a few minutes or less (see for example: Pittenger32). 14. Unreliability in diagnosis of schizophrenia is estimated as quite high by Don Jackson.19 15. Seven of the children were diagnosed at the Kings County Child Guidance Clinic, two at the New York State Psychiatric Institute, and one at the Rockland State Mental Hospital. 16. One can also capitalize on the special situation created by the research by paying special attention to the reactions of family members to the recording and observation. In a still to be completed study on another group of schizophrenic families (the children of which are in a day treatment center) one of the mothers spent a few minutes looking for the location of the tape recorder in the room, only to remark to the son, some time later, that she was not at all "worried about being recorded." 17. "The performance of a small group depends upon the channels of communication open to its members...."30 18. Ordinarily, one would not equate strength of communicational bond with rate and volume of verbal communication only. However, one may be more justified in doing so when using data from a situation which requires all family members to communicate and to communicate with each other. 19. The reader is reminded that we are reporting here on a triad, involving the father, mother, and the identified patient, and that the parents may interact differently with other siblings. 20. We assume that this position is implied by Parsons and Bales a number of times. For example, in this statement: "We will see that particular importance attaches to four familial role types and the subsystems generated by their relations to each other. An important field of study would be that of the effect of absence of any of these many types . . ." (p 37).31 21. We are not implying that these definitions are unique to each family. In part, they derive from the families' group memberships. 22. The significance of viewing behavior as "initiation" or "response" is developed in a series of thoughtprovoking papers by Hilde Bruch (see Bruch, H.11). 23. The reader should not equate this very specific concept of intrusion with the "intrusiveness" attributed to parents of schizophrenic patients. This concept is approximated by our category of level II communication which is described in the third part of the Findings section of this paper. We imply no negative connotation to this notion of intrusion, ie, third person entry into two person interaction. 24. Based on data made available at the Department of Psychiatry of the Jewish Family Service (in collaboration with N. W. Ackerman) and on data made available by Frances Cheek. 25. It has been suggested that a child's rate of intrusion may be positively related to age. Therefore, differences in intrusion rates might be explained if the control children were older than the schizophrenic children. However, as indicated, below (mean and median ages given), the age distribution of the two groups of children is almost alike. 26. Further work is now in progress which categorizes types of intrusion statements made by family members. For example, we shall be able to tell whether intrusions are more likely to be questions, agreements, disagreements with position or with presentation of self, interpretations, etc. Types of responses to intrusion are also under investigation. For example, is it the father or mother who is less likely to permit and respond to intrusion? How, for example, do parents cope with intrusion of the nonpsychotic sibling? 27. In what sense this is understood by the child is an unresolved question and one which deserves attention in studies of infant-mother interaction. 28. In our discussion, we follow the issues of such students of child development as Bruch, Goldfarb, Settlage, etc. Their hypotheses sound reasonable and are relevant to the issues we are exploring. 29. Stanley Schachter suggests that any "normal bodily state will give rise to pressures to decide what is felt, to decide how these feelings are to be labeled."33 Following Schachter, we would postulate that this pressure would result in the soliciting and acceptance of parental interpretation of bodily states. 30. Parsons et al, p 116.31 31. Lennard, H. L., and Bernstein, A., p 183.22 32. In our view, socialization includes the labeling of inner states and their evaluation as appropriate or inappropriate, as desirable or undesirable. 33. Ackerman, N. W.: Family Focused Therapy of Schizophrenia , Jewish Family Service NY, 1959, mimeographed. 34. Ackerman, N. W.: Lectures at Academy of Medicine, March, 1960, unpublished data. 35. Bales, R. F.: Interaction Process Analysis: Method for Study of Small Groups , Cambridge, Mass: Addison Wesley Press, 1950. 36. Bales, R. F.: " Preface ," in Lennard, H. L., and Bernstein, A.: Anatomy of Psychotherapy , New York: Columbia University Press, 1960. 37. Bateson, G., et al: Toward Theory of Schizophrenia , Behav Sci 1:251-264 ( (Oct) ) 1956.Crossref 38. Bateson, G.: Personal Communication to the authors. 39. Bateson, G.: " Biosocial Integration of Behavior in Schizophrenic Family ," in Exploring Base for Family Therapy , N. W. Ackerman, et al, ed., New York: Family Service Association of America, 1961. 40. Bell, N.: Personal communication to the authors. 41. Bowen, M.: " Family Concept of Schizophrenia ," in Etiology of Schizophrenia , D. D. Jackson, ed., New York: Basic Books, Inc., Publishers, 1960. 42. Bowen, M.: in Family Relationships in Schizophrenia , A. Auerback, ed., New York: The Ronald Press Co., 1959. 43. Bruch, H.: Falsification of Bodily Needs and Body Concept in Schizophrenia , Arch Gen Psychiat 6:18-24 ( (Jan) ) 1962.Crossref 44. Epstein, N., and Westley, W.: Patterns of Intra-Familial Communication , Psychiat Res Rep 11:1, 1959. 45. Fleck, S.; Lidz, T.; and Cornelison, A.: Comparison of Parent-Child Relationships of Male and Female Schizophrenic Patients , Arch Gen Psychiat 8:1-7 ( (Jan) ) 1963.Crossref 46. Fleck, S., et al: Some Aspects of Communication in Families of Schizophrenic Patients, paper read before the American Psychiatric Association Meeting, Philadelphia, 1959. 47. Goldfarb, W., et al: " Parental Perplexity and Childhood Confusion ," in New Frontiers in Child Guidance , New York: International Universities Press, 1958. 48. Goldfarb, W.: Childhood Schizophrenia , Oxford: Harvard University Press for Commonwealth Fund, 1961. 49. Haley, J.: Interactional Description of Schizophrenia , Psychiatry 22:321-332 ( (Nov) ) 1953. 50. Haley, J.: Family Experiments: New Type of Experimentation , Family Process , vol 1, No. (2) , Sept, 1962. 51. Jackson, D. D.: " Critique of Literature on Genetics of Schizophrenia ," in Etiology of Schizophrenia , New York: Basic Books, Inc., Publishers, 1960. 52. Laing, D.: Self and Others , London: Tavistock Press, 1961. 53. Leavitt, H. J.: Some Effects of Certain Communication Patterns on Group Performance , J Abnorm Soc Psychol 46:38-50, 1951.Crossref 54. Lennard, H. L., Bernstein, A., et al: Anatomy of Psychotherapy , New York: Columbia University Press, 1960. 55. Lennard, H. L.: " Analysis of Family Conflict ," in Exploring Base for Family Therapy , N. W. Ackerman, et al, ed., New York: Family Service Association of America, 1961. 56. Levinson, D.: Research in Psychotherapy , H. H. Strupp and L. Luborsky, ed., Washington, DC: American Psychological Association, Inc., 1962. 57. Lidz, T., et al: Intrafamiliar Environment of Schizophrenia Patients: II. Marital Schism and Marital Skew , Amer J Psychiat 114:241-248, 1957. 58. Lidz, T., in Panel on Family Therapy , American Orthopsychiatric Association, Washington, DC, March, 1963. 59. Lidz, T., and Fleck, S.: " Schizophrenic Human Integration and Role of Family ," in Etiology of Schizophrenia , D. Jackson, ed., New York: Basic Books, Inc., Publishers, 1960. 60. Miller, D.: in Lecture to Sociology of Mental Health Seminar , Columbia University, New York, October, 1962. 61. Miller, G. A., and Heise, G. A.: Problem Solving by Small Groups Using Various Communication Nets , J Abnorm Soc Psychol 46:327-336, 1951. 62. Morris, J. N.: Uses of Epidemiology , Edinburgh, Scotland: E. & S. Livingstone, Ltd., 1957. 63. Parsons, T., and Bales, R. F.: Family, Socialization and Interaction Process , Glencoe, Ill: The Free Press, 1955, pp 91-94. 64. Pittenger, R. E., et al: First Five Minutes: Sample of Microscopic Interview Analysis , Ithaca, NY: Paul Martineau, 1960. 65. Schachter, S.: Interaction of Cognitive and Physiological Determinants of Emotional State, paper read before Symposium, Psychological Approaches to Human Behavior, Harvard Medical School, Cambridge, Mass, April 18-20, 1963. 66. Shands, H. C.: Thinking and Psychotherapy , Cambridge, Mass: Harvard University Press, 1960. 67. Wynne, L. C., et al: Pseudo-Mutuality in Family Relations of Schizophrenics , Psychiatry 21:205-220, 1958.

Journal

Archives of General Psychiatry – American Medical Association

Published: Feb 1, 1965

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