Thomas M. Gehring, Marianne Debry and Peter K. Smith

  Families are important systems with regard to the physical and psychosocial development of their members and thus deserve the attention and involvement of researchers as well as professionals who work either therapeutically or to prevent psychological and health-related problems. Families can be described as open and dynamic systems consisting of members with reciprocal relationships. The latter are characterised by features such as intimacy, generational differentiation and continuity. Family structures are involved in internal and environmental changes that occur in relation to time and thus have a past, a present and a future. Therefore, an important parameter for understanding family systems is the flexibility of interpersonal patterns. It can be defined as the ability to adapt relational structures to contextually and developmentally determined demands across the life cycle.

Comprehensive family assessment calls for a particular set of foci and techniques that enable the integration of developmental and phenomenological aspects into a systemic perspective on the basis of the hypothesised networks of family structures. However, there is still a paucity of psychometrically validated instruments that meet the distinct requirements of systemic theories as well as clinical practice and research. Evaluation of family systems requires user-friendly and economical diagnostic tools that allow descriptions of the family from the perspective of parents and children of various age groups as derived from individual and interactive settings. Family measures should consider normative aspects and, at the same time, be appropriate for each case in its particular circumstances. In addition, they should also be able to illuminate past and current interpersonal patterns to anticipate future family developments.

Clinicians and researchers from various fields agree that cohesion and hierarchy are two key dimensions that describe family structures. Cohesion is generally defined as emotional bonding or attachment between family members. It includes the regulation of closeness and remoteness between family members. Hierarchy refers to authority, dominance, decision-making power or the amount of influence exercised by one family member over another. An additional issue for the evaluation of family structures is the concept of boundaries. It is used to describe relationships between families and their social environment as well as relationships between various subsystems within the family (e.g., parents and children).

The two most commonly used methods of analysing family relations focus on either the individual or observations of interactions. These two approaches illuminate different aspects of the family and none of them yield a complete picture of the complex family dynamics. Interaction tasks provide data from an outside perspective. As systematic analyses of interactions are time-consuming, these observation methods are not standard in clinical practice and in research. For economical reasons, questionnaires that provide subjective information from a family insider perspective are more frequently used. In general, these questionnaires focus either solely on the family as a whole or on selected dyads and, therefore, yield limited information on family structures. In addition, questionnaires cannot be used with preschool children because they require reading skills.

The increased recognition of figure placement techniques represents an important advancement in family assessment. These tools allow us to measure family structures in individual settings including small children, and they can also be administered as an interactive task. The use of this method in individual and group settings provides information on the respondents' individual and shared family constructs as well as on communication patterns while they are working on their joint representation. Yet, despite their versatility and their three-decade history, figure placement techniques have only recently been systematically used as diagnostic, therapeutic, supervisory and research instruments. Reasons for this delayed acceptance include imprecise description of clinical procedures and the relatively few reliability and validity studies.

The present book provides a comprehensive description of the practical and reserach-oriented importance of the Family System Test, hereafter referred to as the FAST. This clinically derived figure placement technique was designed to assess individual and joint perceptions of the structure of cohesion and hierarchy governing family relations in typical, conflict and ideal situations. The goal of the FAST is to determine psychosocial and health-related issues in system-oriented terms and to facilitate the analysis of family patterns in various research settings, as well as the planning and evaluation of therapeutic and preventive interventions. On the basis of structural family systems theory the test attempts to create an instrument that is both economic and flexible in its application.

The first pilot studies with the FAST were performed with patients and their families at the University of Zurich, Department of Child and Adolescent Psychiatry, in the early eighties. In the initial phase, application and scoring of the test were not yet standardised, since it was more important at the time to explore the range of clinical use for the FAST and its relevance for the conceptualisation of therapeutic interventions. The preliminary evaluation indicated that the FAST is a versatile and flexible tool which facilitates systemic exploration and the development of family-oriented hypothesis. Furthermore, it was shown that even children from the age of six years understood the principle of the test and that it also worked well with people suffering from serious mental disorders.

The FAST subsequently underwent systematic validation with various samples, and a standardised procedure, including a semistructured follow-up interview, was introduced. The psychometric properties of the FAST were established at Stanford University California, Department of Psychology, and a number of studies with nonclinical families were conducted. The Stanford studies were then replicated with Swiss samples. The results showed that family representations of the two groups did not differ significantly. The same holds true for FAST representations of English and Italian samples of adolescents. However, recent research including Asian respondents illuminated that FAST representations are able to capture culture-specific structural differences between Asian and Western families. For example, it has been shown that in nonclinical Japanese families, mother-child relations are perceived as highly cohesive whereas fathers are relatively centrifugal. Therefore, in contrast to Western societies, the existence of 'unclear cross-generational boundaries' is not indicative of dysfunctional family structures in this culture.

Based on the predictions of the structural family theory and the results of Western studies with clinical and nonclinical samples, patterns of family functioning were defined by combining the dimensions of cohesion and hierarchy. This categorical scoring procedure of the FAST saves time-consuming calculations and allows an initial evaluation of family structures as soon as the representations are completed. This is particularly helpful in clinical practice because it promotes the ad hoc use of participative-discoursive problem-solving strategies.

Our book consists of four parts, that focus on different aspects of the FAST as a clinical and research tool; a fifth part contains conclusions and recommandations. The theoretical contributions and studies document the current knowledge drawn from international projects conducted in the past decade and attempt to improve the use of comprehensive systemic procedures for the evaluation and to develop human relationships in the context of the family and other social systems such as clinical teams. The structure of the book allows selected chapters to be read separately.

Part I of this work introduces theoretically and empirically relevant aspects of the field of family psychology, with special emphasis on systemic-structural approaches to assess individual and family functioning in clinical and research settings. The methodological concept of the FAST and its psychometric properties are described, followed by an outline of the significance of systems theory in order to gain insight into the complex organisation of family development. Based on this, an overview of widely used, well validated and conceptually sound family measurement approaches focusing on the interdependence between interpersonal structures and health-related outcomes is presented.

Part II focuses on the application of the FAST in developmental research including data from nonclinical members of various family constellations (e.g. two- and single-parent families). Using samples of preschoolers, first graders, preadolescents, adolescents and young adults, it is shown in what way family constructs are influenced by age and gender of respondents, type of family constellation and the represented situation. For example, the correspondence between perceptions of family structures and offspring's adjustment, and coping in the military service is studied. Using multi-respondent research designs, it is explored how parents and children of the same family view their relational structures.

Part III of this book describes interpersonal constructs of members of modern Japanese families and three-generation Chinese families. Results of the two studies are compared with those as derived from Western samples, and suggestions for an adaptation of the FAST procedure for its use with Asian families are made.

Part IV moves from the more general aspects of individual and family development to specific topics such as assignments of the systematic planning and evaluation of family-oriented interventions in clinical practice. The three contributions delineate the relevance of the FAST for relational diagnosis as well as the conceptualisation of systemic problem-solving processes. Empirical data and a case example demonstrate the significance of a participative-discursive use of this tool in planning, evaluation and supervsion of therapy. Suggestions are made as to how the FAST might favour the emergence of high standards in interpersonal treatment approaches for psychological and medical problems.

Part V draws conclusions and makes recommendations for the future use of the FAST in family evaluation.

This book is planned to be an authoritative and innovative guide for system-oriented researchers, practicioners and students from various disciplines who work with children, adolescents and adults in clinical and nonclinical settings. It is our hope that the versatility of the ideas and findings presented will stimulate a creative application and further development of the FAST in different fields of public health, education and social welfare.