- Email: [email protected]
Methods of measuring interpersonal relationships
J. Psychosomatic
Res.,
1966, Vol. 10, pp. 109 to 117.
Session
6.
Pergamon
Press Ltd.
Interpersonal
Printed
in Northern
Ireland
Relationships
CHAIRMAN: D. A. POND
METHODS
OF MEASURING INTERPERSONAL RELATIONSHIPS NORMAN KREITMAN*
THE notion that the study of interpersonal relationships may have much to contribute to an understanding of mental illness has a venerable history in psychiatric thought, but it is only in the last decade or so that the concept has been subjected to scientific inquiry. This development has resulted not only in an elaboration of observational techniques but also in the application of quantitative methods, and my purpose today is to attempt an outline of the methodological principles on which these attempts at measurement are based. It will not be possible in the time available to pursue technical details, nor to deal with the substantive findings of the studies to be quoted. A preliminary difficulty is that the term ‘interpersonal relationship’ is widely In most formulations ‘interpersonal’ is interpreted as used but rarely defined. referring to a small number of people rather than to large social groups, so I propose to discuss principally the techniques applicable to groups of two and three. The word ‘relationship’, on the other hand, has a wide range of meanings, many of philosophical rather than scientific interest, and as we shall see, many different kinds of concepts are embraced by the term. When classified by their basic theory, the available methods seem to cluster in four or five main groups. 1. EXTERNAL METHODS
The simplest notion of a small group such as a pair, is of two separate individuals who for some reason are juxtaposed. Correspondingly, the simplest way of describing or measuring the relationship is by first determining the position of each individual on some parameter based on a wider population or on some universal dimension, without any immediate reference to the other member, and secondly, by comparing the two readings so obtained. This approach we may term ‘external’ as it is independent of the subject’s own view of himself, the other or the relationship between them. For example, we can specify the relationship of height in a dyad-or in plain English, say which of two people is taller-simply by applying a ruler to each, even * Medical Research Council, Clinical Psychiatry Research Unit, Graylingwell Hospital, Chichester. Present address: Medical Research Council Unit for Research on the Epidemiology of Psychiatric Illness, Royal Edinburgh Hospital, Edinburgh 10. 109
110
NORMANKREITMAN
if we never see them standing back to back. With an instrument like a ruler the measurements derived from each individual enable us, of course, also to specify the interval between them. For psychological variables, which in the present context must be confined to those for which standardized data are available (such as intelligence or certain personality variables) we are unlikely to have an equal-interval scale available, and statements about the magnitude of the interpair discrepancy must be made with caution. A great deal of work has been done using such ‘external’ measurements, as for example in numerous studies of husband-wife concordance on all manner of characteristics such as social class of origin, political outlook, physique and so on and much still remains to be done. Many of these studies are very simple in design and in the expression of their results, but they may also be quite complex since there is no need to confine oneself to studying the same variable in both individuals. As an example we may cite the recent work by Lyman Wynne and his colleagues [l-4]. They studied the ‘cognitive style’ of the first-degree relatives of schizophrenics and severe neurotics. To all these relatives a psychologist administered various projective tests. The protocols were then carefully edited to delete all reference to the patient, and passed to another psychologist who was told for each family only the age and relationship (father, mother, brother, sister) of the individuals. This second psychologist applied an elaborate system of coding to the formal thought characteristics manifest in the protocols, and from these codings ‘predictions’ were made of the diagnosis of the patients and the severity of their illness. A striking degree of accuracy was achieved. This study then, demonstrated a correlation between two ‘universals’-cognitive style ratings of the relative and diagnostic classification of the patient-without however elucidating the mechanism of that correlation or indeed specifying it in Firstly, the ‘external’ method any further way. Two points are worth stressing. is particularly applicable where we are not immediately concerned with the subjective experience of the individuals. Secondly, it will tell us nothing about whether the individuals interact with each other or how they do so. The correlational data typically yielded by this approach poses exactly the same problem of interpretation as any other correlation: does A produce B, B produce A, or C produce both A and B? Applying these two points to the same example, it is evident firstly that cognitive style and psychiatric diagnosis can only be studied by external methods, if only because both are outside the awareness of the subjects, and secondly that the observed correlation, taken alone, does not tell us whether disorders in the relatives have produced the patient’s illness, or whether the latter has in some way led to disordered thinking in the relatives, or if both relatives and patients share a common genetic basis for their disabilities. The situation will sometimes arise when the investigator wishes to measure ‘externally’ the members of a pair or triad on some universal characteristic for which standardized instruments or data are not available. In these circumstances it may be possible to proceed by simply comparing each individual with the others of the same group. Thus in the example of height previously mentioned, each couple could be stood back to back and the direction of the discrepancy noted: from this one might reach some such conclusion as that husbands are commonly taller than their wives. A psychiatric analogy would be where one wishes to test the frequent (and probably incorrect [5]) assertion that the patient is not the sickest member of his
Methods of measuring interpersonal
relationships
111
family. Lacking widely applicable instruments, the investigator may yet feel able to compare the designated patient with each member of his group in turn and simply decide for each comparison which is the more disturbed. It still behoves him, of course, to apply the same definition of ‘disturbance’ in each instance. This method will serve quite adequately in certain situations, but as a general technique it has not only the general limitations of ‘external’ methods, but also yields a minimal amount of information. To the best of may knowledge it has been relatively little used. 2. INTERNAL
METHODS
At the diametrical extreme from these external techniques is another group of methods which may be termed ‘internal’, in which an attempt is made to discover what the individual perceives in uniquely personal terms, and ‘measurement’ depends on comparison between different aspects of the individual ‘monad’ or private world. I am referring here to the semantic differential and personal construct methods elaborated respectively by Osgood [6] and Kelly [7]. They can be summarized by saying that the essential feature is to nominate for the individual a series of objects or persons, and a series of adjectives or terms which can be used adjectivally, and to ask the subject whether (or to what degree) the adjectives are applicable to the ‘nouns’. Any group of objects which receive the same adjectival attributes are assumed to be construed by the subject as similar: conversely, any group of adjectives applied to the same nouns are assumed to have something in common. The technique is capable of considerable flexibility and refinement. The ‘objects’ employed in these tests, particularly the Kelly method, are commonly people, such as the other members of the family, the patient himself or any kind of ideal or fantasy figure. The individual’s perception of these figures using terms previously selected by the investigator, can be readily elicited, especially as the mechanics of the technique are such that the subject is generally unaware of the investigator’s purpose. A ready example of the application of Kelly grid techniques to interpersonal measurements is the work by Dr. Crisp and his colleagues at the Middlesex Hospital who were interested to trace the development of the therapist-patient relationship in the course of behaviour therapy [8]. They demonstrated how the patient viewed his therapist in relation to his ideal parent figure and ideal marriage partner at various points in treatment and concluded that for some patients at least a more positive evaluation of the therapist preceded any behavioural improvement. Two points must be made about this method, which are mirror-images, so to speak, of those made in connection with the external methods. Firstly, we are dealing essentially with the subject’sprivate perceptions, and almost by definition, there can be no way of specifying in detail how these relate to anyone else’s constructs, especially when we are speaking of such complex matters as the perception of another person. Two patients may both declare Dr. Crisp to be just like their respective fathers, yet without other data all we can conclude is that each is drawing a similar conclusion, not that their fathers were in any way alike, nor that their perceptions of Dr. Crisp are similar. The addition of value-judgements such as ‘ideal’ to such perceived similarities considerably complicates the semantic problem but does not resolve it. In practice, it would appear wise to confine the use of this technique at present to (a) studies of the individual patient, where the investigator requires data of the serial perceptions by the patient of specified others, and (b) in
112
NORMANKREITMAN
group-based studies, where the investigator is content to marshal his data under such headings as ‘positively valued’, ‘disliked’ and so on, without requiring any specification of the meaning attributable to such terms. Further developments, however, may well include some way of introducing a system of common referents to grids, thus increasing the comparability of tests from different individuals. Secondly, we may note that however elaborate these techniques may be, they are basically tied to the patient’s subjective view of himself and others: they do not characterize interpersonal interaction. 3. IMPUTATIONAL
METHODS
Another group of techniques may be distinguished which, although by strict logic still of the perceptual or ‘internal’ variety, can usefully be differentiated by virtue of their depending on each member of a pair describing the other: A describes B and B describes A. Usually each person is asked to describe himself as well. If the self-description is taken as a validation criterion, then we have a technique for determining how well one individual ‘knows’ the other. Terms such as ‘empathy’, ‘intuition’ and ‘being understood’ are commonly used by authors employing these methods, of whom Dr. Laing is one of the most distinguished and who will be telling us more about them this morning. Imputational methods can be used on a wide variety of themes. Imputed attitudes and opinions, for example, have been widely studied on an experimental basis by psychologists interested in cognitive dissonance theory. It has been frequently shown that strangers who are introduced to each other in a favourable guise will tend to ascribe to each other opinions resumbling their own and will minimize any evidence to the contrary [9]. The technique has also been used with pairs of friends, fiances or marriage partners, and the ‘theme’ of the test has often been opinions regarding the rules governing the relationship, such as how husbands and wives should behave in different situations. One such enquiry was undertaken by Kirkpatrick and Hobart [lo] who took several pairs of college students who were each others ‘favourite dates’, others who were ‘going steady’ others who were engaged, and These groups conveniently represented different a number of married couples. Each individual completed an opinion inventory relating to stages of courtship. marriage and family roles firstly on behalf of himself or herself and secondly on behalf of the other. There were thus four scores available per couple, and from these the following measures were derived (i) a straightforward disagreement score derived from the self-reports of each, (ii) for the male partner, a non-empathy score, which was the discrepancy between the responses he imputed to the female and her self-report, (iii) also for the male, a disagreement estimate score, being the discrepancy between the male’s self-report and the report he imputes to the female. Indices (iv) and (v) were the corresponding scores derived for the female. Thus the technique yielded five scores in all, which could be related to the different stages of courtship. A number of similar studies have used groups of married pairs with different levels of marital harmony. There is a variation of the approach which almost deserves a separate main heading. Here the ‘theme’ is not attitudes or opinions but the behaviour manifest by each individual towards the other. In short each supplies an account of the interpersonal relationship as he sees it. The questionnaire typically comprises paired statements such as “I sometimes hit her,” and the “She sometimes hits me.” (No sequence
Methods of measuring interpersonal relationships
113
effect is implied). Tests of this kind have been developed by Ryle [ll] and by Dr. Wolf, who will shortly be addressing us and will no doubt be elaborating on this technique, so I will mention it no further. Next we may note analogous tests in which the imputed characteristics are compared not with the other’s self-report, but with the other’s independently-observed behaviour. Ferreira [12] for example, devised a procedure in which each member of a father-mother-child triad performed a series of very simple colouring tasks. The productions of each member were then rotated round the other two for judgement of aesthetic merit. Before the designs were circulated, each individual was asked to estimate, in effect, how the other family members would judge his work. These estimates were then compared with the judgements subsequently made: thus the behaviour of the others was used as a validation criterion of the subject’s expectations. In a group of 50 triads, it was found that it was the child who anticipated the others’ responses with the greatest accuracy. There is little need to elaborate further on these imputational techniques. They can furnish quantified descriptions of mutual perception, and come close to interactional methods proper, though the distinction from these is still worth preserving. 4. INTERACTIONAL
METHODS
Finally, and at long last, we come to a group of methods which may fairly claim to be concerned primarily with the interaction process. In all these, and unlike the methods previously discussed, it is the interactional event on which interest is focussed. The simplest in theory is a straightforward frequency count. If one is interested, for example, in the sexual interaction of two given individuals, one can attempt to discover the actual frequency of sexual intercourse. Analogous to this method is the time budget, in which the joint activities of the individuals over a suitable interval are analysed by the kind of activity in which they were engaged, and appropriate indices then derived. Thus an index of social interaction between two people could be the amount of time spent face to face within the period. When measuring the frequency and/or duration of events, the investigator assumes that there is an objectively true figure, and his skill is directed at forming and repeating his questions, and sifting his data to derive the most accurate estimate. Despite the apparent simplicity of frequency counts and the like, there seems to be very little in the literature about their use in two- and three-person groups. In practice they have certain advantages, but it appears that difficulty can arise particularly with charged topics such as sexual activity: husbands and wives sometimes give remarkably discrepant reports of the frequency of intercourse. An alternative to using self-reports of behaviour is a group of techniques which are applied to a ‘sample’ of interaction as manifest in the presence of the investigator. His presence is bound not only to limit the range of behaviour which can be studied but also to influence the pattern of the interaction. As with any other experimental situation however, conditions can be standardized to a considerable degree and useful quantified data obtained despite, or because of, the artificiality of the setting. Of the different observational methods, we may first consider rating scales. An initial problem concerning their use is the specification of the behavioural dimensions to be rated. Various authors have proposed different factorial models, which fortunately are recognizably similar, as Lorr [13] has recently shown. Three main factors
114
NORMAN KREITMAN
have been suggested which appear to relate to domination, to affection and to involvement versus detachment, though the labels vary. However, although these studies are very helpful, it would be premature to my view to accept this work as definitive, and there is no reason why other and possibly more circumscribed aspects of interaction should not be chosen. The technical requirements of a good rating scale in the present context are, of course, identical to those in any other. Ratings of selected aspects of interpersonal behaviour can be carried out in husband-wife or family interviews by a trained person, and work along these lines is proceeding at the M.R.C. Social Psychiatry Unit at the Maudsley Hospital and in our own Unit at Graylingwell. More specialized rating systems, usually involving a more complicated setting, have also been devised, notably by Bales [14] and by Leary [15]. The former seems to have been the more widely used, despite its complexity. In essence the method involves tape-recording and transcribing a series of verbal exchanges between two or more people, and subsequently dividing the text into very small units. Each item is then allotted to one of a number of categories on the basis of the rater’s judgements. The categories bear such labels as ‘seeks orientation’, ‘gives opinion’, ‘agrees’, etc. The full schema uses 12 categories, but these can be compressed to 6 or 3 larger groupings if desired. A fair amount of information is available now concerning the reliability of the procedure. The Leary method (sometimes called the Kaiser method) is a system of measurements with the unusual claim of being applicable to both intrapersonal and interpersonal processes. It involves a range of instruments including checklists for self and other, and the TAT Hero test. One of its interests to us in the context of interaction techniques consists in its also having been adapted for non-verbal or only partly-verbal interactions such as occurs in children’s ward groups. The observer concentrates on say, one particular child who is involved with other children on a ward in the presence of nursing staff, and records over a short period of time how often he speaks to or approaches others, who it is he interacts with, and the nature of the interaction classified according to a fairly simple scheme. Other methods of measurement claim derivation from communication theory and draw their inspiration in part from the extensive theoretical literature on the family as a culture which prescribes the conduct of its members according to a particular ethos. The emphasis here is on the total interaction as a system, and the investigatorsmost notably Jackson and Haley at Palo Alto-endeavour to determine the ‘rules’ by which the system is governed, exactly as an intelligent Martian may try to discover the rules of bridge by keeping careful records of what is said and done by the players. The guiding hypothesis, generally speaking, is that the utterances of the group members may be perfectly normal when considered in isolation, but that when the sequence of verbal exchanges is considered, pathological patterns may be observed. Typically, three people, the patient and his parents, are brought into the laboratory and induced to talk together by a technique developed by Strodtbeck [16], called the Revealed Differences Technique. This involves ascertaining the views of each subject on a series of topics, and then selecting some on which only two of the three individuals agree. These topics are then presented to the assembled triad for discussion. The communication processes are minutely examined and some of the less complex aspects have been successfully quantified : for example, if the sequence in which individuals speak and to whom they speak is recorded, it can be shown that the
Methods of measuring interpersonal relationships
115
‘system’ between the parents of schizophrenic patients differs from that of controls, and will change according to the clinical state of the patient [17]. Many of the hitherto less quantifiable observations offered by the Palo Alto group, such as that of the ‘double-blind’, are currently being investigated at Harvard by Mischler [IS] who has elaborated a highly complex scoring system applicable to the same laboratory situation, and in which each item of speech is coded on 17 different dimensions. We see then that interactional techniques may focus on the crudest events, or the most refined subtleties of verbal interaction, but in all the emphasis is on what transpires between individuals. In this sense they are both interpersonal and objective, and indeed one of the fascinations of these methods is that unlike most others, the psychological processes can be observed more or less directly and with a minimum of inference. Moreover at least some degree of quantification is usually possible. On the other hand, we must note some of the limitations of interactional techniques. The presence of an observer, whether he participates or not, has certain inevitable consequences. As already mentioned, he is bound to limit the range of behaviour which can be studied, in that interactions of a highly private nature are unlikely to manifest in his presence, and further, the character of the observed interaction is likely to be modified in the interview or laboratory situation to meet the participants’ views of socially acceptable behaviour. Stated in broader terms, one cannot assume a dyadic pattern of interaction to remain unchanged when that dyad becomes part of a triad. These points can be comprised in the question of the validity of the sampling procedure implicit in all observational techniques. There can be no clear answer to the question if only because the ‘universe’of behaviour being sampled cannot be precisely specified. In passing we may note that many investigators have commented on the apparent verisimilitude of their experiments, in which apparently trivial games and footling discussions often have led to displays of high passion and to exchanges between participants which bear the hallmark of real life. The problem of validity will presumably only be circumvented if it can be shown that predictions based on these methods can be verified in a wider context. Exactly comparable problems arise with many other psychological procedures. There is a further highly important consideration regarding interactional methods, so obvious that I hesitate to mention it. It is that one event may have two quite different subjective meanings to the participants, meanings which cannot be directly ascertained by interactional techniques. 5. OTHER
METHODS
There is a further approach not mentioned so far, which emphasizes the relation of the individual to the group of which he is a member, largely irrespective of the personalities involved. This is an elementary concept when we are dealing with how the individual feels about his country, his local community or work group but is perhaps less immediately evident with two- or three-person systems. The distinction between the relationship of the individual to the group, as against that to the other individual or individuals, with a corresponding distinction between the evaluations appropriate to each, can still be made, however; it is implicit when we ask a patient about the state of his marriage rather than how he feels about his wife, and becomes explicit when the patient replies “My wife and I both seem reasonable people, but
116
NORMANKREITMAN
somehow our marriage just doesn’t work.” A similar point perhaps, was made by a Hemingway character who remarked to his mistress, “You are a splendid woman by any standard: I wish to hell you’d go away.” To the best of my knowledge little has so far been achieved in quantifying such sentiments. CONCLUDING
REMARKS
In this brief survey it has been possible only to present an outline classification of some basic methods of measuring interpersonal relationships. I hope it has also been possible to show how these different techniques reflect different conceptual models of human interaction, with the important if obvious corollary that it behoves the investigator pondering the choice of methods first to clarify just what it is he intends to study. I would like now just to mention some of the aspects of the subject it has not been possible to review. The interest here has been chiefly psychological, and nothing has been said of methods derived from general sociological theory, notably the application of the theory of roles and the detailed study of small institutions. Nothing has been discussed of more circumscribed interpersonal reactions such as identification, vicarious learning, or empathy, each of which could provide substance for a whole conference. The contributions of animal studies and ethology have not even been intimated, and there has been no mention of the rapidly expanding branch of experimental social psychology known as small group theory. All of these have quantified techniques to offer, albeit in varied stages of sophistication. It appears, then, that there is no deficit of measurement techniques per se. At the same time, interpersonal psychiatry, including family psychiatry, is in a rather painful state at present, the pain being due to indigestion from a surfeit of theory alternating with hunger pangs from starvation of facts. In this situation there is no place for any premature orthodoxy which insists that only certain lines of inquiry are worth consideration. All available methods hold promise, and given equal vigour of application, no-one can say at present which will eventually contribute most to the study of interpersonal relations. REFERENCES 1. WYNNE L. C. and SINGER M. T. Thought disorder and family relations of schizophrenics I. A research strategy. Archs Gen. Psychiat. 9, 191 (1963). 2. WYNNE L. C. and SINGER M. T. Thought disorder and family relations of schizophrenics II. A classification of forms of thinking. Archs Gen. Psychid. 9, 199 (1963). 3. SINGER M. T. and WYNNE L. C. Thought disorder and family relations of schizophrenics III. Methodology using projective techniques. Archs Gen. Psychiut. 12, 187 (1965). 4. SINGER M. T. and WYNNE L. C. Thought disorder and family relations of schizophrenics IV. Results and implications. Archs Gen. Psychiat. 12, 201 (1965). 5. POST F. The social orbit of psychiatric patients. J. Menr. Sci. 108,759 (1962). 6. Osooo~ C. E. The Measurement ofMeaning. University of Illinois Press (1957). 7. KELLY G. A. The Psychology ofPersona Constructs. Norton, New York (1955). 8. CRISP A. H. An attempt to measure an aspect of ‘transference’. Br. J. Med. Psychol. 37, 17 (1964). 9. BERKOWITZ L. and GORANSONR. E. Motivational and judgment determinants of social perception. J. Abnorm. Sot. Psychol. 69,296 (1964). 10. KIRKPATRICK C. and HOBART C. Disagreement, disagreement estimate, and non-empathetic imputations for intimacy groups varying from favorite date to married. Am. Sot. Rev. 19, 10
(1954). 11. RYLE A. A marital patterns test for use in psychiatric research. Br. J. Psychiat. In press. 12. FERREIRA A. J. Rejection and expectancy of rejection in families. Family Process 2, 235 (1963).
Methods of measuring interpersonal
relationships
117
13. LORR M. and MCNAIR D. M. An interpersonal behaviour circle. J. Abnorm. Sot. Psychol. 67, 68 (1963). 14. BALESR. Interaction Process Analysis. Addison-Wesley, Cambridge, Mass. (1950). 15. LEARY T. Interpersonal Diagnosis of Personality. Ronald Press, New York (1957). 16. STRODTBECK F. Husband-wife interaction over revealed differences. Am. Sot. Rev. 16,468 (1951). 17. HALEYJ. Research on family patterns. Family Process 3,41 (1964). 18. MISCHLER E. Personal communications.
DISCUSSION DR. A. H. CRISP, London I would like to take up Dr. Kreitman’s point about my recent work concerned with attempting to measure ‘transference’ during behaviour therapy. I agree that the concept or ‘construct’ “ideal dependable parent” is a complex one which undoubtedly varies to some extent between individuals. The reason for its use was that the psychoanalytic hypothesis, upon which it is all too crudely based, proposes that the ‘transference’ and the neurotic symptoms often have similar origins in any one patient although their aetiology and structure may vary, at least in degree, between patients. The object of my study was therefore to examine individual patients for such ‘transference’ attitudes in relation to the same individual’s symptoms and to see if there was any ongoing relationship between these two factors during therapy. This there often seemed to be. Dr. Kreitman referred specifically to my earlier study which was made predominantly amongst the ‘normal’ population. In that study significant differences emerged between groups of Social Class 1 and Social Class 3 subjects in respect of their attitudes to the psychiatrist and to their general practitioners, suggesting that there is at least some constancy and value to such complex concepts. In recognizing the need for further analysis of the ingredients of such concepts I am in complete agreement with Dr. Kreitman. DR. N. KREITMAN, Chichester Dr. Crisp’s studies need no defence; I think they are excellent. My point was that Repertory Grid methods, for all their value, suffer certain limitations as a consequence of using the subject’s language without any operational underpinning. One such is the semantic problem of determining how a given subject’s constructs can be related to those of other subjects, if at all. It is certainly interesting to know that certain broad groupings can be empirically derived on a basis of social class, but the essential problem remains, and I think that here Dr. Crisp and I are in agreement.
Res.,
1966, Vol. 10, pp. 109 to 117.
Session
6.
Pergamon
Press Ltd.
Interpersonal
Printed
in Northern
Ireland
Relationships
CHAIRMAN: D. A. POND
METHODS
OF MEASURING INTERPERSONAL RELATIONSHIPS NORMAN KREITMAN*
THE notion that the study of interpersonal relationships may have much to contribute to an understanding of mental illness has a venerable history in psychiatric thought, but it is only in the last decade or so that the concept has been subjected to scientific inquiry. This development has resulted not only in an elaboration of observational techniques but also in the application of quantitative methods, and my purpose today is to attempt an outline of the methodological principles on which these attempts at measurement are based. It will not be possible in the time available to pursue technical details, nor to deal with the substantive findings of the studies to be quoted. A preliminary difficulty is that the term ‘interpersonal relationship’ is widely In most formulations ‘interpersonal’ is interpreted as used but rarely defined. referring to a small number of people rather than to large social groups, so I propose to discuss principally the techniques applicable to groups of two and three. The word ‘relationship’, on the other hand, has a wide range of meanings, many of philosophical rather than scientific interest, and as we shall see, many different kinds of concepts are embraced by the term. When classified by their basic theory, the available methods seem to cluster in four or five main groups. 1. EXTERNAL METHODS
The simplest notion of a small group such as a pair, is of two separate individuals who for some reason are juxtaposed. Correspondingly, the simplest way of describing or measuring the relationship is by first determining the position of each individual on some parameter based on a wider population or on some universal dimension, without any immediate reference to the other member, and secondly, by comparing the two readings so obtained. This approach we may term ‘external’ as it is independent of the subject’s own view of himself, the other or the relationship between them. For example, we can specify the relationship of height in a dyad-or in plain English, say which of two people is taller-simply by applying a ruler to each, even * Medical Research Council, Clinical Psychiatry Research Unit, Graylingwell Hospital, Chichester. Present address: Medical Research Council Unit for Research on the Epidemiology of Psychiatric Illness, Royal Edinburgh Hospital, Edinburgh 10. 109
110
NORMANKREITMAN
if we never see them standing back to back. With an instrument like a ruler the measurements derived from each individual enable us, of course, also to specify the interval between them. For psychological variables, which in the present context must be confined to those for which standardized data are available (such as intelligence or certain personality variables) we are unlikely to have an equal-interval scale available, and statements about the magnitude of the interpair discrepancy must be made with caution. A great deal of work has been done using such ‘external’ measurements, as for example in numerous studies of husband-wife concordance on all manner of characteristics such as social class of origin, political outlook, physique and so on and much still remains to be done. Many of these studies are very simple in design and in the expression of their results, but they may also be quite complex since there is no need to confine oneself to studying the same variable in both individuals. As an example we may cite the recent work by Lyman Wynne and his colleagues [l-4]. They studied the ‘cognitive style’ of the first-degree relatives of schizophrenics and severe neurotics. To all these relatives a psychologist administered various projective tests. The protocols were then carefully edited to delete all reference to the patient, and passed to another psychologist who was told for each family only the age and relationship (father, mother, brother, sister) of the individuals. This second psychologist applied an elaborate system of coding to the formal thought characteristics manifest in the protocols, and from these codings ‘predictions’ were made of the diagnosis of the patients and the severity of their illness. A striking degree of accuracy was achieved. This study then, demonstrated a correlation between two ‘universals’-cognitive style ratings of the relative and diagnostic classification of the patient-without however elucidating the mechanism of that correlation or indeed specifying it in Firstly, the ‘external’ method any further way. Two points are worth stressing. is particularly applicable where we are not immediately concerned with the subjective experience of the individuals. Secondly, it will tell us nothing about whether the individuals interact with each other or how they do so. The correlational data typically yielded by this approach poses exactly the same problem of interpretation as any other correlation: does A produce B, B produce A, or C produce both A and B? Applying these two points to the same example, it is evident firstly that cognitive style and psychiatric diagnosis can only be studied by external methods, if only because both are outside the awareness of the subjects, and secondly that the observed correlation, taken alone, does not tell us whether disorders in the relatives have produced the patient’s illness, or whether the latter has in some way led to disordered thinking in the relatives, or if both relatives and patients share a common genetic basis for their disabilities. The situation will sometimes arise when the investigator wishes to measure ‘externally’ the members of a pair or triad on some universal characteristic for which standardized instruments or data are not available. In these circumstances it may be possible to proceed by simply comparing each individual with the others of the same group. Thus in the example of height previously mentioned, each couple could be stood back to back and the direction of the discrepancy noted: from this one might reach some such conclusion as that husbands are commonly taller than their wives. A psychiatric analogy would be where one wishes to test the frequent (and probably incorrect [5]) assertion that the patient is not the sickest member of his
Methods of measuring interpersonal
relationships
111
family. Lacking widely applicable instruments, the investigator may yet feel able to compare the designated patient with each member of his group in turn and simply decide for each comparison which is the more disturbed. It still behoves him, of course, to apply the same definition of ‘disturbance’ in each instance. This method will serve quite adequately in certain situations, but as a general technique it has not only the general limitations of ‘external’ methods, but also yields a minimal amount of information. To the best of may knowledge it has been relatively little used. 2. INTERNAL
METHODS
At the diametrical extreme from these external techniques is another group of methods which may be termed ‘internal’, in which an attempt is made to discover what the individual perceives in uniquely personal terms, and ‘measurement’ depends on comparison between different aspects of the individual ‘monad’ or private world. I am referring here to the semantic differential and personal construct methods elaborated respectively by Osgood [6] and Kelly [7]. They can be summarized by saying that the essential feature is to nominate for the individual a series of objects or persons, and a series of adjectives or terms which can be used adjectivally, and to ask the subject whether (or to what degree) the adjectives are applicable to the ‘nouns’. Any group of objects which receive the same adjectival attributes are assumed to be construed by the subject as similar: conversely, any group of adjectives applied to the same nouns are assumed to have something in common. The technique is capable of considerable flexibility and refinement. The ‘objects’ employed in these tests, particularly the Kelly method, are commonly people, such as the other members of the family, the patient himself or any kind of ideal or fantasy figure. The individual’s perception of these figures using terms previously selected by the investigator, can be readily elicited, especially as the mechanics of the technique are such that the subject is generally unaware of the investigator’s purpose. A ready example of the application of Kelly grid techniques to interpersonal measurements is the work by Dr. Crisp and his colleagues at the Middlesex Hospital who were interested to trace the development of the therapist-patient relationship in the course of behaviour therapy [8]. They demonstrated how the patient viewed his therapist in relation to his ideal parent figure and ideal marriage partner at various points in treatment and concluded that for some patients at least a more positive evaluation of the therapist preceded any behavioural improvement. Two points must be made about this method, which are mirror-images, so to speak, of those made in connection with the external methods. Firstly, we are dealing essentially with the subject’sprivate perceptions, and almost by definition, there can be no way of specifying in detail how these relate to anyone else’s constructs, especially when we are speaking of such complex matters as the perception of another person. Two patients may both declare Dr. Crisp to be just like their respective fathers, yet without other data all we can conclude is that each is drawing a similar conclusion, not that their fathers were in any way alike, nor that their perceptions of Dr. Crisp are similar. The addition of value-judgements such as ‘ideal’ to such perceived similarities considerably complicates the semantic problem but does not resolve it. In practice, it would appear wise to confine the use of this technique at present to (a) studies of the individual patient, where the investigator requires data of the serial perceptions by the patient of specified others, and (b) in
112
NORMANKREITMAN
group-based studies, where the investigator is content to marshal his data under such headings as ‘positively valued’, ‘disliked’ and so on, without requiring any specification of the meaning attributable to such terms. Further developments, however, may well include some way of introducing a system of common referents to grids, thus increasing the comparability of tests from different individuals. Secondly, we may note that however elaborate these techniques may be, they are basically tied to the patient’s subjective view of himself and others: they do not characterize interpersonal interaction. 3. IMPUTATIONAL
METHODS
Another group of techniques may be distinguished which, although by strict logic still of the perceptual or ‘internal’ variety, can usefully be differentiated by virtue of their depending on each member of a pair describing the other: A describes B and B describes A. Usually each person is asked to describe himself as well. If the self-description is taken as a validation criterion, then we have a technique for determining how well one individual ‘knows’ the other. Terms such as ‘empathy’, ‘intuition’ and ‘being understood’ are commonly used by authors employing these methods, of whom Dr. Laing is one of the most distinguished and who will be telling us more about them this morning. Imputational methods can be used on a wide variety of themes. Imputed attitudes and opinions, for example, have been widely studied on an experimental basis by psychologists interested in cognitive dissonance theory. It has been frequently shown that strangers who are introduced to each other in a favourable guise will tend to ascribe to each other opinions resumbling their own and will minimize any evidence to the contrary [9]. The technique has also been used with pairs of friends, fiances or marriage partners, and the ‘theme’ of the test has often been opinions regarding the rules governing the relationship, such as how husbands and wives should behave in different situations. One such enquiry was undertaken by Kirkpatrick and Hobart [lo] who took several pairs of college students who were each others ‘favourite dates’, others who were ‘going steady’ others who were engaged, and These groups conveniently represented different a number of married couples. Each individual completed an opinion inventory relating to stages of courtship. marriage and family roles firstly on behalf of himself or herself and secondly on behalf of the other. There were thus four scores available per couple, and from these the following measures were derived (i) a straightforward disagreement score derived from the self-reports of each, (ii) for the male partner, a non-empathy score, which was the discrepancy between the responses he imputed to the female and her self-report, (iii) also for the male, a disagreement estimate score, being the discrepancy between the male’s self-report and the report he imputes to the female. Indices (iv) and (v) were the corresponding scores derived for the female. Thus the technique yielded five scores in all, which could be related to the different stages of courtship. A number of similar studies have used groups of married pairs with different levels of marital harmony. There is a variation of the approach which almost deserves a separate main heading. Here the ‘theme’ is not attitudes or opinions but the behaviour manifest by each individual towards the other. In short each supplies an account of the interpersonal relationship as he sees it. The questionnaire typically comprises paired statements such as “I sometimes hit her,” and the “She sometimes hits me.” (No sequence
Methods of measuring interpersonal relationships
113
effect is implied). Tests of this kind have been developed by Ryle [ll] and by Dr. Wolf, who will shortly be addressing us and will no doubt be elaborating on this technique, so I will mention it no further. Next we may note analogous tests in which the imputed characteristics are compared not with the other’s self-report, but with the other’s independently-observed behaviour. Ferreira [12] for example, devised a procedure in which each member of a father-mother-child triad performed a series of very simple colouring tasks. The productions of each member were then rotated round the other two for judgement of aesthetic merit. Before the designs were circulated, each individual was asked to estimate, in effect, how the other family members would judge his work. These estimates were then compared with the judgements subsequently made: thus the behaviour of the others was used as a validation criterion of the subject’s expectations. In a group of 50 triads, it was found that it was the child who anticipated the others’ responses with the greatest accuracy. There is little need to elaborate further on these imputational techniques. They can furnish quantified descriptions of mutual perception, and come close to interactional methods proper, though the distinction from these is still worth preserving. 4. INTERACTIONAL
METHODS
Finally, and at long last, we come to a group of methods which may fairly claim to be concerned primarily with the interaction process. In all these, and unlike the methods previously discussed, it is the interactional event on which interest is focussed. The simplest in theory is a straightforward frequency count. If one is interested, for example, in the sexual interaction of two given individuals, one can attempt to discover the actual frequency of sexual intercourse. Analogous to this method is the time budget, in which the joint activities of the individuals over a suitable interval are analysed by the kind of activity in which they were engaged, and appropriate indices then derived. Thus an index of social interaction between two people could be the amount of time spent face to face within the period. When measuring the frequency and/or duration of events, the investigator assumes that there is an objectively true figure, and his skill is directed at forming and repeating his questions, and sifting his data to derive the most accurate estimate. Despite the apparent simplicity of frequency counts and the like, there seems to be very little in the literature about their use in two- and three-person groups. In practice they have certain advantages, but it appears that difficulty can arise particularly with charged topics such as sexual activity: husbands and wives sometimes give remarkably discrepant reports of the frequency of intercourse. An alternative to using self-reports of behaviour is a group of techniques which are applied to a ‘sample’ of interaction as manifest in the presence of the investigator. His presence is bound not only to limit the range of behaviour which can be studied but also to influence the pattern of the interaction. As with any other experimental situation however, conditions can be standardized to a considerable degree and useful quantified data obtained despite, or because of, the artificiality of the setting. Of the different observational methods, we may first consider rating scales. An initial problem concerning their use is the specification of the behavioural dimensions to be rated. Various authors have proposed different factorial models, which fortunately are recognizably similar, as Lorr [13] has recently shown. Three main factors
114
NORMAN KREITMAN
have been suggested which appear to relate to domination, to affection and to involvement versus detachment, though the labels vary. However, although these studies are very helpful, it would be premature to my view to accept this work as definitive, and there is no reason why other and possibly more circumscribed aspects of interaction should not be chosen. The technical requirements of a good rating scale in the present context are, of course, identical to those in any other. Ratings of selected aspects of interpersonal behaviour can be carried out in husband-wife or family interviews by a trained person, and work along these lines is proceeding at the M.R.C. Social Psychiatry Unit at the Maudsley Hospital and in our own Unit at Graylingwell. More specialized rating systems, usually involving a more complicated setting, have also been devised, notably by Bales [14] and by Leary [15]. The former seems to have been the more widely used, despite its complexity. In essence the method involves tape-recording and transcribing a series of verbal exchanges between two or more people, and subsequently dividing the text into very small units. Each item is then allotted to one of a number of categories on the basis of the rater’s judgements. The categories bear such labels as ‘seeks orientation’, ‘gives opinion’, ‘agrees’, etc. The full schema uses 12 categories, but these can be compressed to 6 or 3 larger groupings if desired. A fair amount of information is available now concerning the reliability of the procedure. The Leary method (sometimes called the Kaiser method) is a system of measurements with the unusual claim of being applicable to both intrapersonal and interpersonal processes. It involves a range of instruments including checklists for self and other, and the TAT Hero test. One of its interests to us in the context of interaction techniques consists in its also having been adapted for non-verbal or only partly-verbal interactions such as occurs in children’s ward groups. The observer concentrates on say, one particular child who is involved with other children on a ward in the presence of nursing staff, and records over a short period of time how often he speaks to or approaches others, who it is he interacts with, and the nature of the interaction classified according to a fairly simple scheme. Other methods of measurement claim derivation from communication theory and draw their inspiration in part from the extensive theoretical literature on the family as a culture which prescribes the conduct of its members according to a particular ethos. The emphasis here is on the total interaction as a system, and the investigatorsmost notably Jackson and Haley at Palo Alto-endeavour to determine the ‘rules’ by which the system is governed, exactly as an intelligent Martian may try to discover the rules of bridge by keeping careful records of what is said and done by the players. The guiding hypothesis, generally speaking, is that the utterances of the group members may be perfectly normal when considered in isolation, but that when the sequence of verbal exchanges is considered, pathological patterns may be observed. Typically, three people, the patient and his parents, are brought into the laboratory and induced to talk together by a technique developed by Strodtbeck [16], called the Revealed Differences Technique. This involves ascertaining the views of each subject on a series of topics, and then selecting some on which only two of the three individuals agree. These topics are then presented to the assembled triad for discussion. The communication processes are minutely examined and some of the less complex aspects have been successfully quantified : for example, if the sequence in which individuals speak and to whom they speak is recorded, it can be shown that the
Methods of measuring interpersonal relationships
115
‘system’ between the parents of schizophrenic patients differs from that of controls, and will change according to the clinical state of the patient [17]. Many of the hitherto less quantifiable observations offered by the Palo Alto group, such as that of the ‘double-blind’, are currently being investigated at Harvard by Mischler [IS] who has elaborated a highly complex scoring system applicable to the same laboratory situation, and in which each item of speech is coded on 17 different dimensions. We see then that interactional techniques may focus on the crudest events, or the most refined subtleties of verbal interaction, but in all the emphasis is on what transpires between individuals. In this sense they are both interpersonal and objective, and indeed one of the fascinations of these methods is that unlike most others, the psychological processes can be observed more or less directly and with a minimum of inference. Moreover at least some degree of quantification is usually possible. On the other hand, we must note some of the limitations of interactional techniques. The presence of an observer, whether he participates or not, has certain inevitable consequences. As already mentioned, he is bound to limit the range of behaviour which can be studied, in that interactions of a highly private nature are unlikely to manifest in his presence, and further, the character of the observed interaction is likely to be modified in the interview or laboratory situation to meet the participants’ views of socially acceptable behaviour. Stated in broader terms, one cannot assume a dyadic pattern of interaction to remain unchanged when that dyad becomes part of a triad. These points can be comprised in the question of the validity of the sampling procedure implicit in all observational techniques. There can be no clear answer to the question if only because the ‘universe’of behaviour being sampled cannot be precisely specified. In passing we may note that many investigators have commented on the apparent verisimilitude of their experiments, in which apparently trivial games and footling discussions often have led to displays of high passion and to exchanges between participants which bear the hallmark of real life. The problem of validity will presumably only be circumvented if it can be shown that predictions based on these methods can be verified in a wider context. Exactly comparable problems arise with many other psychological procedures. There is a further highly important consideration regarding interactional methods, so obvious that I hesitate to mention it. It is that one event may have two quite different subjective meanings to the participants, meanings which cannot be directly ascertained by interactional techniques. 5. OTHER
METHODS
There is a further approach not mentioned so far, which emphasizes the relation of the individual to the group of which he is a member, largely irrespective of the personalities involved. This is an elementary concept when we are dealing with how the individual feels about his country, his local community or work group but is perhaps less immediately evident with two- or three-person systems. The distinction between the relationship of the individual to the group, as against that to the other individual or individuals, with a corresponding distinction between the evaluations appropriate to each, can still be made, however; it is implicit when we ask a patient about the state of his marriage rather than how he feels about his wife, and becomes explicit when the patient replies “My wife and I both seem reasonable people, but
116
NORMANKREITMAN
somehow our marriage just doesn’t work.” A similar point perhaps, was made by a Hemingway character who remarked to his mistress, “You are a splendid woman by any standard: I wish to hell you’d go away.” To the best of my knowledge little has so far been achieved in quantifying such sentiments. CONCLUDING
REMARKS
In this brief survey it has been possible only to present an outline classification of some basic methods of measuring interpersonal relationships. I hope it has also been possible to show how these different techniques reflect different conceptual models of human interaction, with the important if obvious corollary that it behoves the investigator pondering the choice of methods first to clarify just what it is he intends to study. I would like now just to mention some of the aspects of the subject it has not been possible to review. The interest here has been chiefly psychological, and nothing has been said of methods derived from general sociological theory, notably the application of the theory of roles and the detailed study of small institutions. Nothing has been discussed of more circumscribed interpersonal reactions such as identification, vicarious learning, or empathy, each of which could provide substance for a whole conference. The contributions of animal studies and ethology have not even been intimated, and there has been no mention of the rapidly expanding branch of experimental social psychology known as small group theory. All of these have quantified techniques to offer, albeit in varied stages of sophistication. It appears, then, that there is no deficit of measurement techniques per se. At the same time, interpersonal psychiatry, including family psychiatry, is in a rather painful state at present, the pain being due to indigestion from a surfeit of theory alternating with hunger pangs from starvation of facts. In this situation there is no place for any premature orthodoxy which insists that only certain lines of inquiry are worth consideration. All available methods hold promise, and given equal vigour of application, no-one can say at present which will eventually contribute most to the study of interpersonal relations. REFERENCES 1. WYNNE L. C. and SINGER M. T. Thought disorder and family relations of schizophrenics I. A research strategy. Archs Gen. Psychiat. 9, 191 (1963). 2. WYNNE L. C. and SINGER M. T. Thought disorder and family relations of schizophrenics II. A classification of forms of thinking. Archs Gen. Psychid. 9, 199 (1963). 3. SINGER M. T. and WYNNE L. C. Thought disorder and family relations of schizophrenics III. Methodology using projective techniques. Archs Gen. Psychiut. 12, 187 (1965). 4. SINGER M. T. and WYNNE L. C. Thought disorder and family relations of schizophrenics IV. Results and implications. Archs Gen. Psychiat. 12, 201 (1965). 5. POST F. The social orbit of psychiatric patients. J. Menr. Sci. 108,759 (1962). 6. Osooo~ C. E. The Measurement ofMeaning. University of Illinois Press (1957). 7. KELLY G. A. The Psychology ofPersona Constructs. Norton, New York (1955). 8. CRISP A. H. An attempt to measure an aspect of ‘transference’. Br. J. Med. Psychol. 37, 17 (1964). 9. BERKOWITZ L. and GORANSONR. E. Motivational and judgment determinants of social perception. J. Abnorm. Sot. Psychol. 69,296 (1964). 10. KIRKPATRICK C. and HOBART C. Disagreement, disagreement estimate, and non-empathetic imputations for intimacy groups varying from favorite date to married. Am. Sot. Rev. 19, 10
(1954). 11. RYLE A. A marital patterns test for use in psychiatric research. Br. J. Psychiat. In press. 12. FERREIRA A. J. Rejection and expectancy of rejection in families. Family Process 2, 235 (1963).
Methods of measuring interpersonal
relationships
117
13. LORR M. and MCNAIR D. M. An interpersonal behaviour circle. J. Abnorm. Sot. Psychol. 67, 68 (1963). 14. BALESR. Interaction Process Analysis. Addison-Wesley, Cambridge, Mass. (1950). 15. LEARY T. Interpersonal Diagnosis of Personality. Ronald Press, New York (1957). 16. STRODTBECK F. Husband-wife interaction over revealed differences. Am. Sot. Rev. 16,468 (1951). 17. HALEYJ. Research on family patterns. Family Process 3,41 (1964). 18. MISCHLER E. Personal communications.
DISCUSSION DR. A. H. CRISP, London I would like to take up Dr. Kreitman’s point about my recent work concerned with attempting to measure ‘transference’ during behaviour therapy. I agree that the concept or ‘construct’ “ideal dependable parent” is a complex one which undoubtedly varies to some extent between individuals. The reason for its use was that the psychoanalytic hypothesis, upon which it is all too crudely based, proposes that the ‘transference’ and the neurotic symptoms often have similar origins in any one patient although their aetiology and structure may vary, at least in degree, between patients. The object of my study was therefore to examine individual patients for such ‘transference’ attitudes in relation to the same individual’s symptoms and to see if there was any ongoing relationship between these two factors during therapy. This there often seemed to be. Dr. Kreitman referred specifically to my earlier study which was made predominantly amongst the ‘normal’ population. In that study significant differences emerged between groups of Social Class 1 and Social Class 3 subjects in respect of their attitudes to the psychiatrist and to their general practitioners, suggesting that there is at least some constancy and value to such complex concepts. In recognizing the need for further analysis of the ingredients of such concepts I am in complete agreement with Dr. Kreitman. DR. N. KREITMAN, Chichester Dr. Crisp’s studies need no defence; I think they are excellent. My point was that Repertory Grid methods, for all their value, suffer certain limitations as a consequence of using the subject’s language without any operational underpinning. One such is the semantic problem of determining how a given subject’s constructs can be related to those of other subjects, if at all. It is certainly interesting to know that certain broad groupings can be empirically derived on a basis of social class, but the essential problem remains, and I think that here Dr. Crisp and I are in agreement.