Therapeutic formulations using Marital Conflict and Child Psychopathology, as an example
Marital conflicts leads to child psychopathology is too simple an explanation.
What about those kids who's parents are violent and who are perfectly well adjusted when they grow up? Or alternately, those kids who's parent argue minimally, but who land up with difficulties because they catastrophize these arguments ?
This makes it interesting to study the PROCESSES and the mechanisms that are involved to study marital conflicts.
For therapeutic formulations :
These are not simple diagrams with arrows. Unfortunately, we do this in the Indian setting during M.phil training. Simply look at the arrows and gauge the family processes involved, draw diagrams, and voila, the finished product.
Process-oriented research studies the mechanisms involved in the harmful effects of interpersonal conflict and the complex pathways toward child maladjustment. In other words, a study has to show robust evidence for the existence of each arrow that you draw and the effect sizes have to be convincing, while they can. This is the whole reason why we read books like Kazdin, to see the evidence base for studies.
Link : Kazdins book
Link : Process-oriented research
Here is an example of a model that I made, based on actual existing research evidence bases :
A Sample Model depicting parent and child depression using a few relationships between variables that have empirical evidence
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1) a : Depression in the mother can predict a genetic vulnerability in the child
2) b : Depression in the mother can predict parenting behaviors like Rejection / Criticism or High Expressed Emotion
3) c : A child's temperament is influenced by a depressed mother through genetic vulnerability
4) e: Negative Parenting behaviors can predict Negative Schemas or belief systems in the child, moderated by the child's temperament (d)
5) f : Negative Parenting behaviors can also predict lower interpersonal competence in the child
6) g : A child's negative schemas influence his belief in his self-competence which in turn also influence his schema's, negatively
7) h, k : Negative Schemas when mediated by stress exposure can lead to childhood depression
8) i, k : A child with lower interpersonal competence when exposed to stress can develop childhood depression
9) j, k : A child's temperament can predict depression in the child mediated by exposure to stress
So if we wish to study the mechanisms here (mediators, moderators, direct and indirect effects), we should be aware of what various theorists propose and show evidence for. (this is also why its important to study Statistics no matter how much you may dislike it :)
Ref worth a read: Kraemer, Stice, Kazdin, Offord, Kupfer “How Do Risk Factors Work Together? Mediators, Moderators, and Independent, Overlapping, and Proxy Risk Factors” Am J Psychiatry 2001; 158:848–856
1. Exposure to conflict – Impacts child's security needs – this in turn impacts the child's adjustment (Cummings & Cummings, 1988, 1994)
Online ref: http://www.psych.rochester.edu/graduate/developmental/faculty/documents/MaritalconflictgenderChildrensappraisals1994.pdf
Youtube Link : http://www.youtube.com/watch?v=vFd_6ALd0TQ
(about the link : Personally, I disagree with this therapist 'blaming' her parents for something or the other, considering she had a great set of parents who showed 'warmth' toward her. Also there are controversies related to “Time-out's” as of today – May, 2011)
2. Marital conflict – Impacts parenting skills/styles – leads to deficits in parenting – THIS impacts the child's adjustment. The child's adjustment could also be the result of what the behaviorist Bandura (1973) would say - Modeling of the parents
Controversial indian examples that I love to state are the newspaper stories on the dysfunctional political like abusive father-like abusive son stories. (unable to comment on their authenticity, but here are the links : http://www.mid-day.com/news/2009/apr/120409-Pravin-Mahajan-exposes-Pramod-Mahajan-in-tell-all-book.htm
with an emphasis on : "Will my mother deny that Pramod once raised his hand to beat her and isn't Gopinath Munde (sister's husband) aware of this? "
followed by the much publicized Rahul Mahajan story http://www.ndtv.com/article/cities/rahul-mahajan-punched-kicked-and-dragged-me-by-hair-says-wife-dimpy-40901 with the spotlight on : “He punched, kicked and dragged me by hair”
Its most interesting to draw hypothetical models by using these examples and much like a detective, or simply a gossip-hungry psychologist, keep a look out for more news articles, with more information on the family dynamics, and come up with a practice model, as I'd like to call it. Its also a good point of reference, while reading articles in journals. Makes the academic work more applicable in the actual clinical setting.
Word of advice : I like to look not just at syndromal diagnosis but mainly at symptomatic problems while creating my models. So, you need to figure out which is more applicable in what situation. Flexibility is best.
While reading the research its advisable to go in this order :
a. Look at all the methods used in the assessment procedures
b. Then, look at the empirical evidence that supports your hypothesis
c. Finally, focus on the processes involved or the mechanisms of causality or correlation
okay?
Here's an example :
Firstly, ALL parents DISAGREE on things. This means they all have differences of opinions. When do these differences qualify for 'conflict' that can indeed harm a child?
Some interactions on differences positively influence the child's schema's.
Not only is distinguishing the two important, but also studying the differential QUALITY of the interaction and its place in the larger child-parent relationship.
Variations in ACTUAL communication, as well as children's perception of the same are both integral to our model.
“Mom and Dad have a GREAT BIG FIGHT” : http://www.youtube.com/watch?v=DDOmagXum3I MUST WATCH TILL THE END
Measurement in therapy
So, how would you measure parental conflict, if a client was to actually come to you?
- Parent report Questionnaires
- Child report Questionnaires
- Daily records like the Marital Daily Record (please DO NOT think this is a 'thought diary', it in fact is a COMPLEX method for data collection, which can be read about in come of the sites as follows :
Time budget studies : http://drupal.timeuse.org/node/2360 or http://www.celf.ucla.edu/pages/workfamily.php or http://psidonline.isr.umich.edu/Guide/documents.aspx with complex data analysis. Read Larson and Varma (google their names) or Whiting and Whiting to see possible ethnographic accounts and controls for the same. Also read about the Experience Sampling methods.
Code : Tactics Used – Content of the Conflict – Own/partner/child's response
- Observational Coding systems (Example: Facial expression, voice tone, verbal content, bodily gestures)
- Analogue/ Audio / Video methods
(If you want greater details on the above, kindly email me)
“Interparental Conflict in Context: Exploring Relations Between Parenting Processes and Children’s Conflict Appraisals” in Journal of Clinical Child & Adolescent Psychology, 39(2), 163–175, 2010
( I get a bit peeved by the way several studies focus solely on the mother and tend to minimize the fathers role or point out the study limitation as having not included fathers at all! )
Readings : Based on Hudson and Rapee
Using multiple methods will help in obtaining a comprehensive picture : Severity, frequency, tactics and content
Using multiple informants will also help with the same
