A QUESTION CLASSIFICATION SCALE FOR MARRIAGE AND FAMILY THERAPY

Journal of Marital and Family Therapy 1987, Vol. 13, No. 4,375-386

A QUESTION CLASSIFICATION SCALE FOR MARRIAGE AND FAMILY THERAPY

Cynthia Baldwin university of Wyoming

This paper proposes a Question Classification Scale (QCS) to permit more discrimination among the types of questions used in marriage and family therapy. The data base for the QCS development consisted of 503 family therapy questions drawn from tapes of eight family therapy experts and four trainees. The QCS was designed after studying question classification systems in philosophy, lin- guistics, educational research, and individual and family therapy. Each therapist-initiated question is coded in four ways, yielding a simple, yet multidimen- sional, picture of the therapist’s questioning patterns. Future research potential of the QCS is discussed.

Although questions in individual counseling have received a good deal of negative press (Baldwin, 1987), questions are an integral and exciting tool in marriage and family therapy. Leaders in the field have proffered some questioning techniques which attempt to delineate systemic interactions in families (e.g., Bandler, Grinder & Satir, 1976; Haley, 1976; Madanes, 1984; Minuchin, 1974; Papp, 1983; Penn, 1982; Selvini Palazzoli, Boscolo, Cecchin & Prata, 1980). Currently, however, styles and theories about questions in family counseling are as varied as the theorists, themselves. The purpose of this paper is to present a question classification scale that will aid marriage and family researchers and supervisors to examine, codify and improve questioning strate- gies. It is intended as a heuristic bridge between applied therapy and research, and as a tool for trainees and supervisees to focus more clearly on the way questions can be used to capture a systemic view of therapy.

The Question Classification Scale (QCS) for marriage and family counseling was designed by examining, first, the theoretical principles of question classification from other disciplines concerned with the understanding and classification of questions (Bald- win, 1984). It was developed to provide functional and formal understanding of the range of questions used in family therapy and to provide reliability in coding. It was also designed for practical utility in research and training, although this will be more firmly determined by future research. The following section describes the development of the QCS, and then the QCS is described in detail.

METHOD OF DEVELOPMENT

Questions were transcribed from therapy tapes from eight experts and four residents a t The Marriage and Family Residency Program at the University of Iowa to provide a diverse range of potential questioning skills. Question samples were chosen from the first 10 minutes, 10 minutes in the middle of a therapy session and 10 minutes near the

Cynthia Baldwin, PhD, is an Assistant Professor, Department of Counselor Education, College of Education, University of Wyoming, University Station Box 3374, Laramie, WY 82071.

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end of the session, in the event that questioning styles might vary a t different times in therapy.

The unit of transcription was identified by the therapist’s rising vocal inflection, normally followed by a silence, or by a therapist statement with an embedded interrogative phrase followed by a silence. Once a question had been located, the grammatical sentence or phrase immediately preceding the silence was transcribed verbatim or, in the case ofthe embedded interrogative phrase, the statement which contained the phrase was transcribed. The question sample included the first therapist question and at least the following 11 questions. This process of examining three separate segments, for a t least 12 questions on 12 tapes, yielded 503 questions.

The segments were identified ORIY by a code, and all information which could be used to spur recognition (e.g., references to the kind of therapy, the name of the institution) of the source were deleted. This was done to prevent the status of the questioner from interfering with the value of the question.

Content validity for the question classifications was established by separating the question definitions from the examples of each subcategory (cf. Hill, 1978; Hill, Green- wald, Reed, Charles, O’Farrell & Carter, 1981). Then, family therapist volunteers were asked to match the definitions with the examples. The match was near perfect (98%) on the first attempt, and the process did not need to be repeated.

To test the reliability of the QCS, a minimum of two raters were simultaneously trained for 1% to 2 hours to use the QCS with the help of a rater’s manual (Baldwin, 1984). The training proceeded through examples and written definitions for each category and subcategory. The raters were chosen by education level, in general (all were a t least doctoral students), and each had completed at least two semesters of theory course work in family therapy. Each rater coded 60 questions from five different transcripts from five different therapists. During the actual coding, the raters were instructed not to speak to each other and the sequence of transcripts was different for each of the raters.

The interrater reliability was calculated in two ways to provide for comparison with other studies. The first method was the Percentage of Agreement Score (POA) (Bijou, Peterson, Harris, Allen & Johnson, 1969). The second method, which provides a more precise indication of interrater agreement for nominal scales (Pinsof, 1981), was Cohen’s (1960) Kappa, which accounts for reliability with chance agreement removed.

The process of developing a question classification system was structured around the idea of successive approximation. It was assumed that the system would be modified with each stage of testing. After the content validity check, the input from the committee members, comments from each set of raters, and analysis of the rater disagreements in coding, the system was altered. Seven major versions of the QCS were necessary to reach the final result. This was done to provide optimum feedback and clarification on the meaning of the question classifications (Hill, 1978; Hill et al., 1981). Through this process of successive approximation and subsequent feedback from raters, the definitions were clarified, the parameters of the categories were made more succinct, and the interrater reliability increased.

In summary, the QCS evolved from an examination of questions in marriage and family literature as well as multidisciplinary question classification systems, which then was applied to actual questions in marriage and family therapy to provide shape, insight and direction for the scale. The first versions attempted to draw from as wide a pool of question types as possible, “pushing,” as Pinsof (1980) calls it, for diversity and richness. Through the following versions, the terms from other disciplines which were not common, or had different meanings in counseling, were replaced andlor redefined specifically for a therapy orientation. The final, seventh version of the QCS is described here, which is divided into four major categories of question examination: (a) the Time

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Frame in use, fb) the Membership included in the question domain, (c) the Form of the question asked, and (d) the Function of the question. These four categories are each scored and, when examined together, yield a rich and easily readable profile of the type of questioning patterns used in therapy. The following paragraphs describe the contri- butions of each of the four categories to the QCS.

DESCRIPTION OF THE QCS

Category I: Time Frame The Time Frame, or the tense in which a question is focused, plays a vital role in

determining whether the therapeutic dialogue is carried on in the past, present, or future. The time frame is tied to the theoretical constructs of many schools of thought. In individual psychotherapy, for example, Freudians and Neo-Freudians probe the past to determine causes for present behavior (Arlow, 1984). Rogers (1942) advocated interaction focused “on the process and dynamics of immediate personal interactions” (p. 6) . The Milan Associates advocate gathering information around the point in time when the family could no longer cope with a given situation, to help determine the current patterns maintaining the family dysfunction (Selvini Palazzoli et al., 1980). Haley (1976) agrees that “it is a good idea to avoid the past. . . . No matter how interested a therapist is in how people got to the point where they are, he should restrain himself from such explorations” (p. 164). These examples illustrate the integral connection between the time frame focus and the goals of different therapy theorists.

The QCS Time Frame category is organized around the grammatical tense of the verbs rather than the functional sense of some categories as was used in the Family Therapy Coding System (Pinsof, 1980). The TimeFrame (Category I) of the QCS contains six subcategories: (a) Unspecified, (b) Past, (c ) Present, (d) Future, (e) Combination, and ( f ) Subjunctive. The Unspecified subcategory is for those questions which are ainbig- uous or do not contain a verb (e.g., “How about Paul?”; “No?”; ‘Rnd how old?”).

The Past subcategory of questions refers to events, experiences or relationships which have already occurred, and are indicated by the past tense ofthe verb (e.g., “Mary wanted to go, too?”). Past tense is usually formed by internal vowel change (as in sang) or by the addition of a suffix (as in laughed) that is expressive of elapsed time. Present perfect forms (i.e, has written, have lived) and past perfect forms (i.e., had written, had lived) are included under past.

Present tense questions focus on events, experiences or relationships happening now (e.g., “What is happening?“).

The Future questions are in the future tense and focus on events, experiences or relationships which are going to happen. These future events are addressed with an air of certainty (e.g., “What will your parents do?”). Future perfect tense (i.e., he will have written) is also included in the future.

Combinations of tenses occurring within one question are categorized under Com- binations. This category is used when phrases or dependent clauses within the question use different time frames (e.g., “Has it happened or is it coming up?”).

The Subjunctive subcategory represents questions which act or state a possibility- how events might be or might have been if conditionally altered (wish), rather than being a fact. The subjunctive form normally uses “if‘ to propose the hypothetical1 con- dition (e.g., “What would happen if she left?”). The subjunctive form was included here because of its theoretical importance. Subjunctive, or “wish” forms, are highlighted in certain therapeutic styles. In individual psychotherapy, for example, Adler asks, “If I had a magic wand or a magic pill which would eliminate your symptom immediately, what would be different in your life?” (Ansbacher & Ansbacher, 1956). Satir suggests an opening question to determine the goals of therapy: “If you could change yourself

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and your family in any way you want, what changes would you make?” (Bandler & Grinder, 1975, p. 129). Without this category, the unique approach of these types of questions would not be apparent in rating.

Category 11: Membership The Membership category is the sum total of persons explicitly designated within

the question, or those implicitly designated as respondent by the personal nature of the question. Its purpose is to highlight how many members are actually being addressed by the question. For family therapy theorists, the number of people included in the dialogue is very important. As Haley (1976) points out,

As family therapists began to accept views that were more social, they began to interview married couples as well as whole families together. During this period couples began to be described as dyads . . . they (family therapists) began to see that a dyad was unstable. . . . If a husband and a wife regularly communicate to each other through a third person, the unit is three people. (pp. 152-153).

Tomm and Wright (1979) recommend “including the whole executive subsystem in the therapy process as much as possible” (p. 232). The Milan Associates, in defining the active process of circularity in counseling technique, state: “By circularity we mean the capacity of the therapist to conduct his investigation on the basis of feedback from the family in response to the information he solicits about relationship and, therefore, about difference and change” (Selvini Palazzoli, 1980, p. 8).

In an effort to capture this systemic emphasis on the relationships between family members, the Membership category was included. To all of these theorists and many others, how one includes family members and interacts with them is germane to the success of the therapeutic process. Five subcategories are included in the Membership category: (a) unspecified, (b) single, (c) dyad, (d) triad, and (e) multiple.

UnspecifiedlAmbiguous. Unspecified/Ambiguous questions are those in which the therapist does not explicitly deal with people or where the question is too incomplete or ambiguous to determine the membership (e.g., “That’s the mental health authority?” is ambiguous as to whether “authority” refers to a person or institution).

Single. Single membership questions indicate one respondent or person explicitly denoted in the question (e.g., “Are you listening to that request?”). An implicit respondent is counted only when the question is on a personal topic (e.g., “And it’s exhausting to keep cheerful?”, implies you by the personal topic of the question).

Dyad. Dyad membership occurs when a question deals with two personal units (persons or groups) or any aspect of the relationship between two personal units (e.g., “Mary wanted to look pretty?” is coded as a dyad because “you” [implied singular] are asked about Mary, resulting in two personal units).

n i a d . Triad membership is counted when a question deals with three or more specifically designated groups or personal units (persons and/or groups), or any aspect of the relationship between them. Often, this is one respondent and two other personal units as objects (e.g., ‘!Are your mom and dad happy?” has you [the respondent], mom and dad as members).

Multiple. Multiple membership refers to undifferentiated group members (e.g., all of you, they, we, kids, doctors, us, let’s see, none) within a question (e.g., “Let’s go, ok?”).

Category 111: Form Form refers to the grammatical structure or syntax of a question. Form is concerned

more with how a question looks (structurally) rather than what meaning it conveys. The four major divisions of Form in the QCS are: (a) Nonverbal, (b) Verbal Indirect, (c) Verbal Direct Closed, and (d) Verbal Direct Open. (Although this category is struc-

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turally based on Kearsley’s [1976] form classification, it contains elements of other theoretical perspectives as well, and most of Kearsley’s linguistically oriented titles were changed and the definitions adapted for use with therapeutic questions.)

Nonverbal questions. Nonverbal questions are questions communicated by methods other than direct verbal interaction. These can be done in an Overt way, such as with shoulder shrugs or quizzical facial expressions. Nonverbal questions can also be internal or Covert questions one asks and answers oneself. These nonverbal questions cannot be detected with written transcripts, but have been included for future coding of video tapes of therapy sessions. Additionally, their inclusion provides a descriptive name, a place in the question hierarchy and a definition for these kinds of questions which do occur in therapy.

Verbal Indirect. Verbal Indirect questions refer to declaratives containing embedded interrogative phrases. These are sentences and do not have question marks, but they serve the question’s purpose of eliciting a verbal response from the respondent (e.g., “I wonder where the house is”). This technique of containing embedded interrogative phrases in therapist statements is mentioned by Benjamin (1969) and also emphasized by Bandler et al. (1976).

Verbal Direct Closed. Verbal Direct questions are direct questions which have a question mark “?” when written and are spoken with a rising vocal pattern. Verbal Direct Closed questions are those which limit options of response to yes or no or to a few suggested choices. This definition is similar, but not the same, as that frequently cited in counseling literature. Hill et al. (1981), for example, define a closed question as one in which “a counselor is asking for a specific answer-convergent thinking” “p. 7). Kearsley’s (1976) definition, which is used in the QCS, limits closed questions to those in which the set of possible answers is specifically limited to a confirmation or denial response or a choice specified by the speaker. The advantage of this conservative definition of closed question is that is based on the limited options permitted by the questions, not just based on the length of the answer of the respondent. This strategy has the additional advantage of separating the form of the question (i.e,, the domain or response permitted by the question) from the function of the question (i.e., how long a respondent can make his or her response).

Types of Verbal Direct Closed questions further itemized in the QCS are: (a) Yest No Simple, (b) Yes/No ‘Pag, (c) Intonated, and (d) Specified-Alternative. YeslNo Simple questions are straightforward requests for confirmation or denial from the therapist (e.g., “Will you be in town next Friday for your appointment?”). YeslNo Tag questions are declarative statements with a short question tacked on the end. The form is determined by the ending “tag,” which usually begins with an inverted auxiliary verlb (e.g, “you two want to separate, is that it?”). Intonated questions are declarative stateiments or phrases requesting confirmation or denial, which are made into a question by iraised intonation. These receive a question mark when transcribed, due to the raised intonation. However, they are easily detectable by removing the “?“ and seeing if the question is a declarative statement (e.g., “Your mom never expects your help?”). Specified-.Alter- native questions are those where specific acceptable answers are provided within the question and are detectable by the presence of “or” indicating choices (e.g., “Do you want to move out or stay?”). Benjamin (1969) refers to these as “eithedor” questions and highlights the limits of this type of questioning in therapy. Long, Paradise and Long (1981) refer to this type of questioning as a “multiple-choice question” and state “at first thought, these questions appear to be open ended, but they are really closed queistions since the client is given a limited set of responses from which to reply” (p. 25).

Verbal Direct Open. Verbal Direct Open questions refer to direct questions which have a question mark “?“ when written, are spoken with a rising vocal patterin and which permit an unrestricted set of answers, even though the correct answer may require

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only one word. Verbal Direct Open questions are further itemized into Simple, Embedded Questions, Embedded Commands and Complex Questions.

Simple refers to an open direct straightforward request (e.g., “What ideas do you have?”) or a word or phrase that serves the same purpose (e.g., “And?”), and often begins with a Wh-question (who, what, why, when, where, how, which, whose). An Embedded Question is a Wh-question which appears open but contains a hidden unintended complete closed question which can be answered with a yeslno response (e.g., “Why did you do that?). To answer the main question, it is assumed that the embedded question is already confirmed. Long, Paradise and Long (1981) used several of these embedded questions as examples in two categories (“why questions” and “accusative questions”) describing inappropriate uses of questions, but they did not isolate the phenomenon of the embedded question as a reason for this inappropriateness. The Embedded Command is a Wh-question which appears open but contains one or more hidden commands (e.g., “Why don’t you take a second and explain these to your mom?). It normally suggests the respondent do something (whereas the same hidden commands without the question form would demand that the respondent do something). It functions in much the same way as the Verbal Indirect Question, but the Verbal Indirect Question is a declarative statement followed by a period whereas the Embedded Command is a Wh-question followed by a question mark. Bandler et al., (1976) refer to this style of polite commands as “conversational postulates.” Complex questions are open direct questions containing two or more explicit or implicit Wh-Question references (e.g., “So what is it that happens when she cries?”).

To summarize, the Form of questions (Category 111) was classified into four major divisions: (a) Nonverbal, (b) Verbal Indirect, (c) Verbal Direct Closed and (d) Verbal Direct Open, with a total of eleven subcategories, two of which were not applicable to written transcripts. While the characteristics of the “open” and “closed” questions used in counseling are mostly focused on structure and were subsumed under this category, form distinctions made here changed those definitions somewhat. The form was determined primarily on the basis of structural characteristics and may serve as a future base of research to determine which forms are more effective or more frequent in given situations.

Category IV: Function Function refers to the meaning or import of the question conveyed to the respondent

(i.e., function is semantically oriented). There are three divisions which are used to clarify the subcategory choices: (a) Basic Information Gathering, (b) Contextual Infor- mation Gathering, and (c) Less Relevant Functions.

Basic Znformation Gathering. Basic Information Gathering questions are those which make simple direct requests for information or for the respondent’s opinion. Basic Information Gathering is divided into four subcategories: (a) Request for Repeat, (b) Request for Information, (c) Request for Confirmation or closed judgment, and (d) Request for Open Judgment.

Request for Repeat refers to questions which request a repeat of previous communication or fragments which imply the previous statement. was not understood (e.g., “Pardon?”, or, “I’m sorry, what was that again?”). Request for Znformation refers to a simple request for factual information or additional information (e.g., “How old is your father?”) and includes questions designed to establish the addressee’s knowledge of the subject (as in an exam). Confirmation or Closed Judgment Request asks for a confir- mationldenial that the previous communication had been understood by the therapist (e.g., “Are you sure of that?”) or by someone else, or may request the respondent’s closed judgment (Yes/No-type) or agreement (“You like long legs?”). This subcategory can be further divided to indicate that the request for confirmation is a reflection of content,

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feeling or an additive combination of previous material and empathy which stem from microcounseling techniques as described by Carkhuff (19691, Carkhuff and Berenson (1976), Ivey (1971), Ivey and Gluckstern (1976) and others. However, these subcategory distinctions proved difficult to determine without a full transcript and were not used here. These distinctions have been retained for use in future studies which use a video tape or complete transcript.

Reflection of Content is rated when the question dominantly reflects a paraphrase of the facts or content of some statement, and it requests confirmation or denial of the content as understood. When a therapist asks someone else to check out the accuracy of the content, this is also coded this way. Reflection of Content questions are often declarative statements, with the question indicated by the rising intonation at the end of the statement. Reflection of Feeling dominantly reflects the feeling import of respondent, requesting affirmation that the feeling was accurately understood. These are often declarative statements, with the question indicated by rising intonation at the end of the statement. Reflection of CombinationslAdditive is used when both a reflection of content and feeling are represented in the question andor additive empathy may also be reflected. Open Evaluative Judgment is a question which solicits an opinion or an explanation of something without restricting the range of answers (e.g., “What’s your explanation?”). This includes open-ended greeting questions.

Contextual Information Gathering. Contextual Information Gathering refers to the function of collecting information in response to the feedback from the family in response to the information solicited about relationships, differences and change. It is drawn from the work on circularity of the Milan Associates (Selvini Palazzoli et al., 1980) and further described by Penn (1982). The purpose is to discriminate the patterns and information requested by the therapist. The four subsets of Contextual Information Gathering are: (a) Relationships, (b) Sequence, (c) Comparisons, and (d) Hypothetical Possibilities.

Relationships indicate those questions which highlight one person’s relating to others. There must be at least a membership of a dyad or a triad designated in the question and the interaction or relationship between the members must be the focus of the question (e.g., “How do you two show affection?”). Sequence is coded for a question when something happens, will happen, or has happened relative to some event (e.g., “Then what do you do after the blowup?”) or when duration or patterns of behaviors are discussed (e.g., “YOU were straight for how long?”). Words such as when, how long, again, now, and then, are indications that a question should be coded as a sequence. Compar- isons are questions characterized by the systematic comparison of phenomena and especially of likenesses and dissimilarities (e.g., “IS Karen a better helper to you than Tim?”). They are normally formed by modifying an adjective or adverb to denote different levels of quality, quantity or relation (e.g., most, least, fuller, fullest). Even if part of the comparison is not articulated in a question, the appearance of a comparative adjective or adverb in the major clause would normally result in using this subcategory. Hypo- thetical is a question which proposes a possibility or a wish (“Suppose she were willing to take you back, would you go?”). It often appears with the conditional “if” (‘‘If you could change anything in your family right now, what would that be?”).

Less Relevant Functions. Less Relevant Functions consist of questions which are normally incidental to counseling interactions but, nonetheless, occur. They may play a part in the “social stage in which the family is greeted and made comfortable” (Haley, 1976, p. 15). They are the lowest functions and are coded only when no higher level function is meaningful. These subcategories are drawn again from Kearsley (1976), but rhetorical questions are mentioned by linguists (e.g., Aqvist, 1975)) philosophers (e.g., Cohen, 1929), educators (e.g., Dillon, 1982), and counselors (e.g., Benjamin, 1969; Long

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et al., 1981). There are four subcategories in this division: (a) Defied Description, (b) Rhetorical, (c) Verbosity, and (d) Attention-Getting.

Defies Description refers to gibberish or some technical blunder which is undeci- pherable. Rhetorical are questions which are posited but to which no answer is expected or required (e.g., “It’s all the same, you know?” or, “Pat, why don’t I start with you?’). Verbosity refers to questions asked out of politeness to sustain conversation but are not connected with any important information gathering (e.g., “HOW ‘bout them Hawks?”). In counseling, Verbosity would be difficult to determine without a complete transcript. Attention-Getting is a type of question used to gain control of the dialogue; “Listen to me!” is the metacommunication, and the question permits the respondent only to ask a question in return, giving the original questioner permission to continue (e.g., “Hey, you know what?“ or, “Do you know what I heard about Alice?”).

To summarize, the Question Classification Scale (QCS) has drawn from a number of perspectives on questioning and is rooted in the concepts unique to family therapy. It utilized four major categories of Time Frame, Membership, Form, and Function in developing a system for describing questions. The QCS was designed to permit a wider variety of discrimination of questions within a logically organized suprastructure which, hopefully, can be used to blend questioning behavior with therapy outcomes in future research.

RESULTS AND DISCUSSION

Specific choices were made in organizing the QCS in logical and judicious construction. The QCS was based on a nominal scale construction which means discrete behaviors were assigned to separate categories. Due to the number of subcategories under each category, specificity was not sacrificed by using nominal scale construction in the QCS. The use of an ordinal system would have permitted indications of intensity of certain functions, but since this scale pattern did not fit the first three categories of the QCS as well as an ordinal scale, it was not used. To capture a bit of the variety possible in the function of a question, the Function Category was provided with two optional columns in which alternative or additive functions can be coded. Channel isolation was used in coding to help assure that raters judged what they were supposed to be judging with the least amount of contamination (Pinsof, 1981). Questions from the beginning, middle, and end of eleven original transcripts were transcribed. The question was determined to be the speech unit preceding the raised vocal inflection, normally followed by silence, or the speech unit containing an indirect question followed by silence.

Interrater reliability for the QCS was determined both with the Percentage of Agreement (POA) (Dollard & Auld, 1959) and Cohen’s (1960) Kappa. Both levels displayed increased interrater reliability for each of three rater pairs over three training episodes: POA-Training Episode #1: .68, .67, .65; #2: .68, .78, .71; and #3: .73, 20, .80; Kappa-Training Episode #1: .63, .58, .60; #2: .63, .75, .67; and #3: .70, .77, .79.

The four categories within the QCS consistently had different levels of interrater reliability: Category I (Time Frame) had an average POA of .83, .86, and .85 on the three training episodes; Category ZZ(Membership) had an average POA of .75, .77, .95; Category IZI (Form) had an average POA of .65, .57, .72; and Cutegory I V (Function) had an average POA of .36, .69, .59. As these numbers illustrate, the interrater reliability normally decreased with each successive category within a given training episode. This can be accounted for in several ways:

1. The number of items to be rated in each category increased, making the task increasingly difficult for the raters.

2. The categories required an increasing level of “untangling” of the variables to differentiate them from other codes.


3. The coding criterion became increasingly more complex with each category, making the methodological task increasingly difficult for the raters.

While it is logical that more complex functions will be less reliable, efforts to adjust the descriptions of the QCS categories did have an impact on improving the level of interrater agreement in some categories from the first training episode to the last. One of the dilemmas in constructing the QCS was to find a balance between making the categories concrete so that the rating was easy, and yet meaningful enough that they captured important family therapy questioning practices. The respectable, but variable, reliability levels which go down as the categories become more complex, may indicate that an acceptable balance has been achieved.

The practical application or utility of the QCS is still at the inital stages of testing. However, the prognosis for the utility of the QCS at this point is very positive. The final raters were trained in 2 hours initially and received an additional hour of training to examine incongruent responses and practice together on sample questions, bringing the total training time to 3 hours. This training time for the QCS’s four categories and total of thirty-four subcategories compared favorably with the 10 training hours necessary for Hill’s (1978) Counselor Verbal Response Category System with its 17 categories.

In addition to the high levels of rater agreement achieved within a comparatively short training time, the QCS rating scores permitted an immediate scan of a therapist questioning sequence. The changes in the Time Frame were easily detected at a glance, and provided a temporal map of the session as directed through the questions of the therapist. The Membership of those involved in the question was immediately detectable by the l’s column of numbering system in the code: No personal referent is 20, one personal referent is 21, a dyad is 22, a triad is 23 and undifferentiated groups are 24. Of course, the rules of how specifically to code the separate categories were slightly more complex than this, but the final result was an easily readable account of how many people the therapist included in any given question. The Form category was divided into 3 major divisions: (a) ~ O ’ S , which refer to verbal indirect questions, (b) 50’s which are concerned with various closed question forms, and (c) the 60’s, which are concerned with various open question forms. The Function category, too, displayed 3 levels of complexity through its numbering and could be detected at a glance. A predominance of any one or more of these codes indicated a persistence of use of that style of questioning, and may provide a clue to the effectiveness or ineffectiveness of different questioning techniques.

Limitations of the QCS and Future Directions While the QCS has much to offer in expanding the awareness of the types of

questions used in therapy, it also has some clear limitations. The most important limitations center around what the QCS does not capture:

1. It does not discriminate changes in the meaning of a question which are due to altered emphasis.

2. It does not deal with the duration, placement, speed or multiple questions of the therapist and the effect these factors may have on the response.

3. The QCS contains no clues as to who actually responds to a question. 4. It limits the knowledge of the question to the unit within which it is confined.

This means that a non-specific referent (e.g., it) may have been defined by a previous therapist statement but it would not be acknowledged unless the definition was in the questioning unit.

5. It does not assess the appropriateness of a therapist question within the context of the session.

6. It does not capture some of the other important systemic theoretical ideas such as questions connected with joining, reframing, paradox, defiance- or compliance-based


therapy. After many attempts to define and operationalize these types of concepts, it was determined that these concepts were too amorphous, could not be easily operation- alized and did not often take a question form that could be reliably coded.

In addition to these limitations, the choice of a nominal scale construction rather than an ordinal scale construction had its own innate limitations. The nominal scale, which is based on discrete independent units, can attain a high level of specificity, but does not have the capacity to describe variability (i.e., degrees of intensity-least effective, most effective) on the items coded. This lack of descriptive variability was only a problem in the Function category. This limitation was alleviated, somewhat, by the addition of two optional columns. When a rater determined multiple functions were at work in the same question, he or she was encouraged (though not required) to code those additional functions in the optional columns. In future research, these multiple functioning characteristics of a question may be one of the factors that separate the normal questions from those which are truly pivotal questions in the change process. When research reaches in that direction, the Function category and its additional columns may need to be expanded into an ordinal scale.

Limitations in the scope, sensitivity, variability, and structure are clear. However, these limitations also serve as boundaries, helping the researcher determine what is actually being captured and what is not. While the QCS was “pushed for richness” (Pinsof, 1980) in the discrimination of questions whenever possible, it contains only those items which were well grounded in questioning theories and could be operation- alized in a meaningful way for family therapy.

One of the potential uses of the QCS would be to determine whether therapists espousing different theoretical orientations actually operationalize their theories in therapy. As Orlinsky and Howard (1978) pointed out, without careful specifications and observations, there is a “danger of assuming that there is a close correspondence between professed orientation and actual behavior” (p. 290). In other words, one of the major difficulties with research is that the actual processes used in therapy (such as questioning style) are not necessarily highly correlated with the theoretical orientation of the therapist. With the QCS, the specific questioning behavior of family therapists could be checked against theoretical claims. For example, Penn (1982), makes theoretical statements about both the time frame sequencing of questions and the functioning of questions in therapy-both of which could be validated (or more carefully described) by analysis of the actual dialogues of therapist questions using the QCS.

In the area of training and supervising family therapists, beginning therapists could periodically code the kinds of questions they use. When ineffective questions occur, or the novice is baffled with the responses of the family, an analysis of the questions asked could prove very fruitful in correcting the therapist’s questioning approaches to the family. The training of therapists and the effectiveness of supervisors has been a continuing concern in therapy (e.g., Bowen, 1966; Holloway, 1982; Kersey, 1982). Yet, as Gurman and Kniskern (1981) point out, “we must acknowledge and underline the field’s collective empirical ignorance about this domain of training and supervision” (p. 772).

The QCS has been designed primarily to permit closer scrutiny of the questions used in family therapy and, subsequently, to build on that knowledge to improve the effectiveness of questioning in therapy. The areas in which the QCS could be most useful initially are in theoretical validation, training, and supervision. Eventually, it is hoped that closer attention to the way therapists ask questions will lead to more effective, efficient, and sensitive questioning of families in therapy.

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Queens College . Program . Marriage & Family Counseling

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presents Culture &

Family Therapy: Allies for Change

with Monica McGoldrick

November 13,1987

8th Annual Conference Plus 5 Additional Workshops

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. For information and registration contact: . Queens College 8

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A QUESTION CLASSIFICATION SCALE FOR MARRIAGE AND FAMILY THERAPY

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