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GARF

Global Assessment of Relational Functioning
by

Nick Puchalski

on 29 October 2012

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Transcript of GARF

GARF Conclusion Thank you for your attention! Purpose of Assessment
Tool of relational function (GARF vs. GAF)
What is Measured?
Global Assessment and 3 Sub-Scales
Clinical Rating Scale
Began NOT as self-reporting instrument
Self-Report Fairy Tale Metaphor Tool
Time-frame for Rating
Present (as clinician observes)
Multicultural Implications
Language relatively clear and bias-free General Assessment In 1980 the DSM became the most widely used document to describe and categorize mental disorders

1983 an evaluation of the DSM III was held

1986 The Group for the Advancement of Psychiatry (GAP) - family committee began discussing relational issues and how to introduce it into the DSM IV

OBJECTIVE GARF! What is THAT? GARF: Scoring and Interpretation The History of GARF! Global Assessment of Relational Functioning GARF I - Background and Rationale study
Anecdotal reports from a number of family therapists rate it satisfactory to excellent in reliability
1996 article sites 3 key studies conducted in Texas, New York, and Montreal
GARF II - Reliability and Validity - Families of Bi-Polar Patients
Rated reliably by relatively inexperienced raters who have been trained to use a standardized manual
Applied across different family constellations
Scores on the scale are related to measures of family functioning that have been found to have prognostic validity in different psychiatric patients
Ratings are independent of patients' co-existent illness states GARF: Reliability/Validity/Standardization Vignette & Personal
Responses to GARF GOODBYE! the degree to which a family or other ongoing relational unit meets the affective or instrumental needs of its members Sub-Scales Interactional/Problem Solving
Organization
Emotional Climate Scoring Process: Scale runs from 1-100:
1-20 = chaotic
21-40 = rarely satisfactory
41-60 = predominantly unsatisfactory
61-80 = somewhat unsatisfactory
81-100 = satisfactory Scoring Possibilities:
One overall score (ex. 33)
Range of 5 (ex. 49-53)
Range of 20 (ex. 80-99) When to score:
Each session
Pre/Post Therapy
Intermittently Throughout Therapy HISTORY The objective was to characterize family functioning
And rate that functioning on a continuum from 1 - 100. GOALS:
To be used as a common language between and among clinicians
Used by all mental health professionals
Not require much therapist time
And be applicable to any family form:
single-parent, same-sex, adult siblings, aged parents, etc To meet the goals it was necessary that the scale:
NOT closely be aligned with any particular family therapy, or family functioning
Conceptually straightforward and not require any special training to administer Family Therapist felt it fell short and did not take into account the context with which a person lives

Family, marital and interpersonal issues were relegated to V codes:
Conditions not attributed to a mental disorder that are a focus of attention and treatment Lyman Wynne was the lead and his group discussed the inadequacies of the DSM III for families
American Family Therapy Association viewed the DSM:
Over focusing and even misdirecting attention exclusively on the individual level
Possibly leading to neglect of observations relevant to diagnosis and treatment 1988 Early versions of Global Assessment of Relational Functioning tried in 1988 by GAP
1994 GARF comes of age
GARF was specifically designed to be included in the DSM IV
Designed by Lyman Wynne and colleagues
Legitimized the importance of relationships in mental health
It was the first DSM recognition of interpersonal relationships described as a criteria
It was patterned after the Global Assessment Functioning scale that comprises Axis V
Was not placed on a major Axis
In the criteria sets and Axes provided for further study Example

During the first four years of their marriage, Evelyn and Alec Morgan had a quite satisfying relationship, especially during weekends and vacations together. However, since the birth of their 3-year old son Shawn, they have had escalating arguments about how to deal with his frequent temper tantrums and whether they, an African American couple, should move to a house in a white racially homogenous neighborhood. Their repeated, intense arguments have often involved their families of origin and have been followed by long periods of silence and avoidance; their sexual relationship has become unsatisfactory. Evelyn complains that Shawn does not call for her at night, wanting only his father. Shawn is often left at daycare longer than necessary because the parents are not talking to one another and have not agreed on when and by whom he is to be picked up. Only rarely do they now have a pleasant evening or weekend together. Evelyn is considering a separation. 2010
Growing body of literature supporting validity and reliability
Consistent inter-rater reliability between different raters rating the same in-take session
Strong Validity related to measures of family functioning, relational satisfaction, or depressive symptoms
Even when raters are untrained in using GARF the outcomes are similar References Reliable, but not valid Not Reliable, Not Valid Reliable and Valid IN CASE YOU FORGOT... Wide range of uses for families challenged by:
Domestic violence, battering, and incest
Members diagnosed with schizophrenia, phobias, depression, alcoholism, additions, and other mental health disorders
Physical illnesses such as cancer or Alzheimer's
Traditional issues seen by MFT's - marital problems, family generational problems, etc More independent studies with larger samples are needed to further evaluate the validity and reliability in a variety of settings with diverse clients Fairy Tale Metaphors! Ugly Duckling: (1-20 = Chaotic)
Relational unit has become too dysfunctional to retain continuity of contact and attachment Hansel and Gretel: (21-40 = Rarely satisfactory
Relational unit is obviously and seriously dysfunctional; forms and time periods of satisfactory are rare
Cinderella: (41-60 = Predominately unsatisfactory)
Relational unit has occasional times of satisfying and competent functioning together but clearly dysfunctional, unsatisfying relationships tend to predominate Little Red Riding Hood: (61-80 = Somewhat unsatisfactory)
Functioning of relational unit is somewhat unsatisfactory. Over a period of time, many but not all difficulties are resolved without complaints The Three Bears: (81-100 = satisfactory)
Relational unit is functioning satisfactorily from a self-report of participants and from the perspective of observers Global assessment of relational functioning scale (GARF): I. Background
and rationale. (1996).Family Process, 35(2), 155-172.
doi:10.1111/j.1545-5300.1996.00155.x

Dausch, B. M., Miklowitz, D. J., & Richards, J. A. (1996). Global
assessment of relational functioning scale (GARF): II. Reliability and
validity in a sample of families of bipolar patients. Family Process,
35(2), 175-189. doi:10.1111/j.1545-5300.1996.00175.x

Denton, W. H., Nakonezny, P. A., & Burwell, S. R. (2010). Reliability and
validity of the global assessment of relational functioning (GARF) in
a psychiatric family therapy clinic.Journal Of Marital & Family
Therapy, 36(3), 376-387. doi:10.1111/j.17520606.2009.00144.x

Yingling, Lynelle, C., Miller, William, E., McDonald, Alice, L., Galewaler,
Susan, T. (1998).GARF assessment source book: Using the DSM IV
global assessment of relational functioning. Washington, D.C.:
Taylor and Francis.
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