Journal of Child and Family Studies, Vol. 14, No.

3, September 2005 (

C 2005), pp. 357–372

DOI: 10.1007/s10826-005-6848-0

Family Ritual and Routine: Comparison

of Clinical and Non-Clinical Families
Laurel J. Kiser, Ph.D., MBA,1,5 Linda Bennett, Ph.D.,2
Jerry Heston, M.D.,3 and Marilyn Paavola, LCSW4

Research demonstrates that the constructive use of family rituals is reliably linked
to family health and to psychosocial adjustment. This study explores the rela-
tionship between family rituals and child well-being. Two samples participated:
21 families whose adolescent was receiving psychiatric treatment and 21 families
in which the adolescent was a public school student. A parent and the adolescent
were individually interviewed regarding family rituals and completed standard-
ized measures of adolescent and family functioning. Analyses demonstrated that,
in addition to significant sample differences in the expected direction on measures
of functioning, the non-clinical families scored significantly higher on the index
of family rituality than did the treatment families; this is additional evidence that
family rituals are a correlate of child well-being. Further analysis of the data
pointed to “people resources” as a robust dimension in its association to ado-
lescent functioning. The role family ritual and routine plays in defining family
relationships, both within the nuclear family and with other important adults, was
significantly related to clinical status. This work may point to an important, yet

1 Associate Professor, Division of Services Research, Department of Psychiatry, University of Maryland

at Baltimore, Baltimore, Maryland.
2 Professor of Anthropology and Associate Dean for Graduate Studies and Research, University of
Memphis, Memphis, TN.
3 Associate Professor, Division of Child and Adolescent Psychiatry, University of Tennessee, Memphis,
Memphis, TN.
4 Instructor, Division of Child and Adolescent Psychiatry, University of Tennessee, Memphis, Memphis,
TN.
5 Correspondence should be directed to Laurel Kiser, University of Maryland at Baltimore, Division
of Services Research, 685 West Baltimore Street, MSTF 300, Baltimore, Maryland 21201; e-mail:
lkiser@psych.umaryland.edu.

357
1062-1024/05/0900-0357/0

C 2005 Springer Science+Business Media, Inc.
358 Kiser, Bennett, Heston, and Paavola

overlooked, dimension of family ritual life, the relational qualities of rituals and
routines.
KEY WORDS: family; rituals; adolescents; well-being; relationships.

Research clearly demonstrates that the constructive use of family rituals is

reliably linked to family health and to psychosocial adjustment in children. In a
family context, ritual may be defined as complex behavioral practices that are acted
out systematically over time. Family rituals encompass three general categories:
celebrations, such as holiday observations and rites of passage; traditions, such as
birthdays and anniversaries; and patterned routines, such as dinner times. Although
family rituals are universal, they are observed with considerable diversity and
with change and continuity interwoven into their practice over time (Rosenthal &
Marshall, 1988).
Researchers theorize that the performance of rituals has healthy consequences
for families, especially for children and, to date, have generated strong empiri-
cal evidence for this premise. Initial investigation of the potential mediating role
of family rituals was with alcoholic families (Bennett & Wolin, 1990; Bennett,
Wolin, & Reiss, 1987; Steinglass, Bennett, & Wolin, 1987; Wolin, Bennett, &
Noonan, 1979). In a series of studies, Wolin and Bennett (1984) found that plan-
ning and maintaining family rituals such as dinner times, holidays, and family
celebrations was associated with significantly less transmission of alcoholism and
problem drinking into the next generation. Fiese (1992, 1993) and Hawkins (1997)
replicated these early findings.
Furthermore, Bennett, and Wolin (1990) reported that deliberateness, as an
underlying process in carrying out family rituals, was a promising dimension of
family rituals for supporting child well-being. Highly deliberate couples planned
the sort of family they wanted to have early in their marriage–including ritual
activities–and then successfully followed through on those plans by keeping their
rituals distinct from the parental alcohol abuse behavior (Bennett et al., 1988a, b).
Regardless of presence of alcoholism in the family, children living in families that
scored low on deliberateness in regards to their family ritual life showed more
behavior problems than children from highly deliberate families (Bennett, Wolin,
& McAvity, 1988).
Additional studies of the protective role of family ritual functioning focus on
adjustment to illness, disability, and changes in family membership. For example,
predictability of family rituals was an important factor to patients’ coping with
chronic pain while the meaning of the rituals was important to the spouse’s ad-
justment (Bush & Pargament, 1997). In children suffering from asthma, practice
of meaningful family rituals, along with child health severity and family percep-
tion of asthma severity, made a significant contribution to lower reports of child
anxiety. For mothers, report of high ritual meaning was related to lower anxiety
scores in their children while for fathers, report of high ritual routine was related
Family Ritual and Routine 359

to lower anxiety scores (Markson & Fiese, 2000). Bucy (1995) demonstrated the
value of meaningful family rituals and routines for parents in dealing with the
added stresses of caring for a disabled youngster.
Ritual observance has also been found to be helpful given changes in family
membership. Fiese et al. (1993) studied 115 couples with very young children and
found that the practice of meaningful rituals was related to marital satisfaction
during these stressful early parenting years. Following the death of any member,
adjustment is facilitated by the family’s ability to reorganize daily functioning and
to reestablish emotional control (Shapiro, 1994). Post-divorce, children’s internal-
ization of stress is related to decreased functional family routines, as measured by
the Family Roles subscale of the Family Assessment Device (Portes et al., 1992).
Finally, evidence in support of the promotive role of family rituals to ad-
justment in childhood comes from the Add Health study (Resnick et al., 1997).
Results of this survey (12,118 subjects in grades 7 through 12) of risk and pro-
tective factors related to adolescent health indicated that family connectedness
provided protection from every health risk behavior except pregnancy. Family
connectedness was measured by the presence and participation of parents with
their children in daily family routines, such as getting up in the morning, having
regular dinner and bedtime, and in shared activities.
Overall, results of these studies demonstrate that the constructive use of
rituals provides one way that families maintain their health and the health of their
individual members (Braithwaite et al., 1998; Bush & Pargament, 1997; Markson
& Fiese, 2000; Viere, 2001). Given the strength and breadth of the evidence
that family rituals, traditions, and routines are tied to basic family processes and
improve the family’s protective functioning, it is reasonable to hypothesize that
family rituals might differentiate between clinical (family with an adolescent in
treatment for mental health problems) and non-clinical families (family with non-
referred adolescent).
Close examination of the evidence confirming the association between con-
structive family rituals and child adjustment indicates that there is significant
diversity in the manner in which families practice rituals and that the practice of
constructive rituals within a family is multi-dimensional with different dimensions
salient to different family members under specific circumstances. For example, in
studies on alcoholic families, deliberateness of family ritual life was significantly
related to transmission of alcoholism and to the emotional and behavioral function-
ing of children. In other studies, the meaning associated with rituals appeared to be
more salient. Given these findings, we thought it important to explore the specific
dimensions of family ritual life related to adolescent mental illness. Finally, as
Markson and Fiese (2000) suggest, the skills involved in carrying out constructive
family rituals are not entirely dissimilar from other elements of family functioning
that contribute to child welfare, such as parenting practices and positive affect,
so we also examine the question of whether specific dimensions of family rituals
contribute to child psychosocial adjustment beyond general family functioning.
360 Kiser, Bennett, Heston, and Paavola

We examined the following three hypothesizes: (1) Constructive use of family

rituals will differentiate between families of adolescents with moderate to severe
psychiatric disturbance and families with an adolescent not identified due to mental
illness. (2) Specific aspects of family ritual life will be significantly associated with
adolescent behavior problems. (3) Specific aspects of family ritual functioning will
make a unique contribution to the association with adolescent behavior problems
beyond general family functioning.

METHOD

Sample

Parent(s)/care-giver(s) and an older child from forty-two families were in-

terviewed individually regarding family ritual activities over the life course of the
current generation. Two samples of families participated.
We recruited one sample through the Day Treatment Program of the Division
of Child and Adolescent Psychiatry, University of Tennessee, Memphis (Kiser
et al., 1984, 1989) (N = 21). Adolescents treated in this program ranged in age
from 11 to 18 years. Each adolescent was moderately to severely affected with
a diagnosable psychiatric disorder and parental, marital, and family functioning
were also moderately to severely disturbed. Major categories of disturbance being
treated in this program include affective disorders (30.6%), anxiety disorders
(18.9%), and behavioral disorders (22.7%).
The second sample consisted of families in which the adolescent was a
student in a selected public school recruited through a family resource center
(N = 21). Family Resource Centers are facilities tied to public schools. Family
Resource Centers provide support for families and facilitate parent involvement
in the schools; they do not provide clinical services. Families were approached
by the Center Director, who introduced the study and asked for permission to
have a member of the research team contact them. Three families who originally
indicated a willingness to participate refused when contacted by the research team.
No information was collected on these families.
Demographic characteristics of the two samples are presented in Table I.
Specifically, the clinical sample included significantly more Caucasians (8 fami-
lies) than the non-clinical sample (1 family) (x 2 = 5.09; df = 1; p < .05). There are
no significant differences between the two groups with respect to age and sex of the
adolescent, education, and occupation level of the mothers, and family structure.

Procedures

Parent/caregiver(s) and adolescents agreed to participate in the study and

completed consent forms. Data collection involved an initial telephone contact
Family Ritual and Routine 361

Table I. Demographic Comparison of Clinical and Non-Clinical Samples

Variable N Clinical Non-clinical Test value df p-value

Sex of adolescent 42 χ2 = 0.88 1 n.s.

Male 24 14 10
Female 18 7 11
Age of adolescent 42 M = 13 M = 14.14 t = −1.85 40 n.s
(1.84) yrs (2.15) yrs
Race 42 χ 2 = 5.09 1 <.05
Caucasian 9 8 1
Non-caucasian 33 13 20
Mother’s education 35 χ 2 = .24 1 n.s.
8–12 yrs 17 9 8
13–18 yrs 18 11 7
Mother’s occupation 37 χ 2 = 3.87 4 n.s.
Professional 11 7 4
Technical 7 3 4
Service 13 4 9
Unemployed 5 3 2
Student 1 0 1
Family structure 42 χ 2 = 2.59 3 n.s.
Two-parent bio 12 5 7
Two-parent blended 3 2 1
One parent 22 10 12
Other relative 5 4 1

Note. Numbers inside parentheses are standard deviations.

with the adult family member through which demographic information involving
the family was gathered. This information included: names, ages, occupations,
and education of all family members. During the initial contact, an appoint-
ment was scheduled for parent(s)/caretaker to complete a series of paper and
pencil questionnaires regarding their child’s functioning (Child Behavior Checklist
(CBCL), Achenbach, 1991a) and their family functioning (Family Environment
Scale (FES), Moos & Moos, 1986) and for adolescents to complete the Youth Self-
Report (YSR) (Achenbach, 1991b) and FES. These appointments were generally
scheduled within 14 days of the initial contact.
To assess family rituals, trained clinical interviewers conducted independent
interviews with the identified adolescent and a primary caretaker adult(s). The
family ritual interviews were transcribed in full. The University of Tennessee
Memphis’ IRB approved the study before implementation.

Measures

Child Behavior Checklist (CBCL) and Youth Self Report (YSR) (Achenbach,
1991a, b) are instruments designed to record behavior problems of children ages
4–18 years. Each instrument requires the respondent to rate the extent of 118
362 Kiser, Bennett, Heston, and Paavola

behavior problems. Nine behavior problem subscales can be further collapsed into
two general behavioral groups (Internalizing versus Externalizing) and into a Total
Problem score. Reliability and validity have been well established and reported
elsewhere.
Family Environment Scale (FES) (Moos & Moos, 1986) is a 90-item self-
report instrument designed to measure the social-environmental characteristics of
families. The scale comprises ten subscales that measure three underlying dimen-
sions of family life: relationship, personal growth, and system maintenance. Initial
reports of instrument psychometrics were acceptable, however, more recent stud-
ies have raised concerns about the instrument’s internal consistency and subscale
structure (Boyd et al., 1997; Loveland-Cherry et al., 1990; Roosa & Beals, 1990).
Accordingly and consistent with our interest in general family functioning, only
total FES scores were used.
The Family Ritual Interview (Wolin et al., 1979) follows a semi-structured
format with the following topics covered in order: religious background and current
religious-related activities in the family; story-telling in the family; deliberateness
in planning for the future of the family and the results of that early planning thus
far; people resources during times of financial, emotional, social, physical need
of the family; and detailed descriptions of two daily routines and of two special
occasions and activities (rituals).
For 41 families, 21 in the clinical and 20 in the non-clinical sample (one tape
was not able to be transcribed due to poor sound quality), a holistic, consensus
scoring approach with a focus on the main theoretical concepts of the study was
adopted. Three investigators independently read each of the interview transcripts.
Readers were instructed; on the one hand, to take into account the entire data
set from an interview, while they were also provided criteria for scoring 13 fam-
ily ritual variables on a three-point Likert scale from low to high: (1) extent of
religious activity, (2) importance of religion, (3) quality of relationships within
the immediate family, (4) problem-solving ability within the immediate family,
(5) quality of extended relationships, (6) extent of extra-family networks, (7)
availability of people resources, (8) overall level of family ritual activity, (9) pos-
itive feelings about ritual observances, (10) continuity of ritual observances over
time, (11) clear definition of roles in carrying out family rituals, (12) expecta-
tions for planning and carrying out rituals, and (13) follow-through on plans for
rituals.
At scoring meetings, the three readers derived a family score on each of
the 13 variables by considering information from both the parent and adolescent
interviews. LB led a discussion of each dimension, reviewed each coder’s thoughts
and rationale, and negotiated a final consensus score. As family system processes,
such as rituals, are made up of each individual’s different constructions of reality
(Sabatelli & Bartle, 1995), this qualitative coding procedure allowed us to make use
of both the mother’s and the adolescent’s perceptions of family ritual functioning.
Family Ritual and Routine 363

To summarize the interview data, a cumulative “rituality” index was cal-

culated by summing the scores for all 13 variables. Four subscale scores were
also calculated and include: Religiosity/spirituality [extent of religious activity,
importance of religion], Ritualization [overall level of family ritual activity, posi-
tive feelings about ritual observances, continuity of ritual observances over time,
clear definition of roles in carrying out family rituals], Deliberateness [expec-
tations for planning and carrying out rituals, follow-through on plans for ritu-
als], and People Resources [quality of relationships within the immediate fam-
ily, problem-solving ability within the immediate family, quality of extended
relationships, extent of extra-family networks, availability of people resources].
The interview, format, and coding of interview data were developed on the ba-
sis of prior research of family rituals in alcoholic and non-alcoholic families
(e.g., Bennett et. al., 1987, 1988b; Jacob & Tennenbaum, 1988; Wolin et al.,
1979).

Analysis

To confirm sample differences between the clinical and non-clinical fami-

lies, initial data analyses using t-tests for independent samples and chi squares
were conducted on child and family functioning measures. To determine if use
of family rituals would differentiate between clinical and non-clinical families,
separate t-tests for independent samples were conducted on overall family ritual
scores and the four family ritual subscales. To test if specific aspects of family
ritual life were associated with adolescent behavior problems, correlation analy-
ses using Pearson’s r were performed using family rituals subscales scores and
adolescent behavior problems as measured by YSR and CBCL Total Problems
T-scores.
Finally, to determine if specific aspects of family ritual functioning made
a unique contribution to predicting adolescent behavior problems, two types of
analyses were conducted. First, correlation analyses were conducted to assess
associations between FES scores obtained from parents and adolescents with
YSR and CBCL. Then, a series of multiple regression analyses (MRA) were
conducted using YSR and CBCL Total Problem T-scores as dependent vari-
ables in each analysis. In each series of MRA, the first model used race as
the single independent variable. In the second model, the two ratings by par-
ents and adolescents of FES were entered with race in the same equation. This
allowed us to assess the independent effects of the two FES measures on ado-
lescent behavior problems. In the last MRA, subscale scores were entered in
the analysis while controlling for the two FES measures and race to assess
the unique effect of specific aspects of family rituals on adolescent behavior
problems.
364 Kiser, Bennett, Heston, and Paavola

Table II. Comparison of DTP and SCH Groups on Adolescent Behavior Problems and Family
Functioning
Mean (SD)
Instrument Subscale n1, n2 Clinical Non-clinical t-value p-value

YSR Externalizing 19,21 63.95 (11.55) 51.10 (13.46) 3.22 <.01

Internalizing 19,21 61.32 (12.91) 50.76 (8.78) 3.05 <.01
Total problems 19,20 64.53 (13.05) 50.70 (11.15) 3.56 <.001
CBCL Externalizing 20,21 72.75 (11.54) 50.52 (12.33) 5.95 <.000
Internalizing 20,21 68.20 (12.76) 49.81 (11.71) 4.81 <.000
Total problems 20,20 72.50 (10.75) 50.65 (12.91) 5.82 <.000
FES Parent Total score 18,21 5.26 (.87) 6.13 (.83) −3.22 <.01
FES Adolescent Total score 17,20 5.17 (.96) 5.92 (.68) −2.76 <.01

Note. n1; sample size for clinical; n2; sample size for non-clinical.

RESULTS

Clearly and importantly, results indicate significant differences between the

two samples with regard to child and family functioning (refer to Table II). Analy-
ses indicate that the clinical sample reported significantly more behavior problems
and family dysfunction than the non-clinical sample. Significant differences across
the summary subscales of the YSR and CBCL indicate that, indeed, the adolescents
in these two samples were functioning differently. Adolescents in the clinical sam-
ple, as opposed to those in the non-clinical sample, expressed significantly greater
concern over their own behaviors and emotions. Their parents agreed, on aver-
age rating their children’s problems in the clinically significant range while the
mean t-scores reported by the parents of the non-clinical sample indicated that
they endorsed few, if any, of the problems seen in a clinical population. On the
FES, parent/caretakers and adolescents in the clinical sample reported significantly
lower scores than the parents and adolescents in the non-clinical sample.
Having established that these two samples do, in fact, differ significantly in
child and family functioning, we turn our focus to their ritual life. From the ritual
interviews, we learned a great deal about the rituals and routines carried out by
these families.

Family Rituals and Clinical Status

To explore the hypothesis that family ritual functioning is related to clini-

cal status, we tested differences between the two samples on overall family rit-
ual functioning using the cumulative index of rituality. The non-clinical families
(M = 2.59) scored significantly higher than did the clinical families (M = 2.35)
(t = −2.07, df = 39, p < .05).
Family Ritual and Routine 365

We also tested differences between the two samples on specific aspects of

family ritual functioning using the family ritual interview subscale scores. The non-
clinical families (M = 2.58) scored significantly higher than the clinical families
on the People Resources subscale (M = 2.15) (t = −3.52, df = 39, p < .01).
The other three subscales did not significantly distinguish the families according
to clinical status.

Family Rituals and Child Behavior Problems

To determine whether family rituals are significantly related to child be-

havior, we ran correlations between family ritual cumulative index of rituality
and subscale scores and Total Problem scores (T-score) on the CBCL and YSR.
Significant correlations were found for cumulative index of rituality with To-
tal Problem scores on the CBCL (r = −.40, p < .05) and people resources
subscale with Total Problem scores on the CBCL (r = −.56, p < .001) and
YSR (r = −.42, p < .05). No significant correlation was found between the
cumulative index of rituality with Total Problem scores on the
YSR.

Family Rituals Beyond General Family Functioning

Our final analyses explored the hypothesis that specific aspects of family
ritual functioning make a unique contribution to the association with adolescent
behavior problems beyond general family functioning as measured by the Family
Environment Scale (FES). Initial analyses related to this hypothesis explored the
relationships between FES total scores and adolescent behavior problems. Results
indicate significant correlations between adolescent FES total score and YSR
(r = −.38, p < .05), adolescent FES total score and CBCL (r = −.47, p < .05),
parent FES total score and CBCL (r = −.52, p < .01). No significant correlation
was found between parent FES total score and YSR.
Results of the first set of MRAs using YSR T-scores as dependent variable
indicate that People Resources did not make a significant unique contribution to
the prediction of adolescent behavior problems. The second series of MRAs used
CBCL T-scores as the dependent variable. Results show that People Resources
made a significant contribution to the explained variance (9.8%) of youth’s be-
havior problems beyond that explained by family functioning and race. Higher
scores in People Resources were associated with lower CBCL scores (b = −1.43;
t = −2.19; p < .05). Further, parent FES had a significant unique effect on
adolescent behavior problems in the expected direction (b = −.63;
t = −2.28; p < .05). MRA results are summarized in
Table III.
 366

Table III. MRA on adolescent behavior problems

Model A Model B Model C
Parameter Std Parameter Std Parameter Std
Sources of variations estimate (b) error t-value estimate (b) error t-value estimate (b) error t-value

DV: YSR
Intercept .509 .231 2.21∗ 3.274 1.784 1.84 3.895 1.845 2.11
Race 1.305 .544 2.39∗ 1.076 .653 1.65 1.049 .654 1.60
FES-parent −.104 .259 −.40 −.061 .271 −.22
FES-adolescent −.405 .302 −1.34 −.216 .340 −.63
People resources −.808 .576 −1.40
Model F -value 5.74; df = 1,37; p = .022 2.92; df = 3,30; p = .050 2.65; df = 4,28; p = .054
R2 .134 .226 .274
DV: CBC
Intercept .850 .266 3.19∗∗ 7.250 1.946 3.72∗∗∗ 8.376 1.893 4.42∗∗∗
Race 1.537 .596 2.58∗∗ .841 .712 1.18 .806 .671 1.20
FES-parent −.694 .282 −2.46∗ −.635 .278 −2.28∗
FES-adolescent −.427 .330 −1.30 −.081 .350 −.23
People Resource −1.433 .591 −2.43∗
Model F-value 6.67; df = 1,38; p = .014 5.85; df = 3,30; p = .003 6.14; df = 4,28; p = .001
R2 .149 .369 .467
∗p < .05; ∗∗ p < .01; ∗∗∗ p < .001.
Kiser, Bennett, Heston, and Paavola
Family Ritual and Routine 367

DISCUSSION

We examined family rituals that occurred naturalistically within two samples

of families. As prior research has shown, family rituals and routines can be severely
affected by chronic problems in the family, such as parental alcoholism. Based
on previous research and clinical experience, this study hypothesized strong links
between family rituals, traditions, and routines and clinical status. Results demon-
strated that non-clinical families scored significantly higher on the index of family
rituality than did treatment families. Findings from this study also demonstrated
a strong relationship between family rituals and child behavior problems. This is
additional evidence that family rituals are indeed a correlate of child well-being.
To better understand the function served by rituals within the family it is nec-
essary to consider which protective and promotive dimensions of ritual behavior
may foster healthy family functioning and improve child psychosocial adjust-
ment (Fiese & Wamboldt, 2000). A variety of different systems for characterizing
family ritual practice have been suggested, such as on a continuum from under-to-
over-ritualized (Fiese & Wamboldt, 2000; Hecker & Schindler, 1994; Mize, 1995;
Roberts, 1988; Wolin et al., 1979). Researchers also recognize specific dimensions
of family ritual life, such as routine practices or structure, ritual importance or
meaning, deliberateness or persistence, and adaptability or flexibility (Baxter &
Clark, 1996; Bush & Pargament, 1997; Fiese, 1992; Fiese & Kline, 1993; Fiese &
Tomcho, 2001; Markson & Fiese, 2000; Poch, 1994; Schuck & Bucy, 1995). Two
dimensions of family rituals, routine and meaning, have received considerable
support across a number of studies (Fiese & Tomcho, 2001).
Our study suggests another dimension of family ritual functioning “people
resources” that proves to be robust. In this study, the role family ritual and routine
plays in defining family relationships, both within the nuclear family and with
other important adults, appeared to differentiate between clinical and non-clinical
families. Our work may point to an important, yet overlooked, dimension of
family ritual life, the relational qualities of rituals and routines. This dimension
delineates the people who are often included in the routines and traditions of the
family, the range and quality of immediate and extended family relationships, and
the ability of the family to use these resources for coping and problem solving.
Strong and positive family connections inclusive of good communication, positive
interactions, caring, support and involvement, and clear roles are created and
reinforced by the practice of family rituals characterized by repeated patterns of
interaction over time (Fiese, 1996; Wolin & Bennett, 1984).
Making use of the qualitative data from the family ritual interviews can help
illustrate the “people resources” dimension. One of the most striking differences
between the families who received high scores on the ritual index and those who
received low scores was the role of the parent(s) in setting a tone and expectations
for family life. Often the head of the household, typically the mother, established
368 Kiser, Bennett, Heston, and Paavola

the meaning of relationships within the nuclear family system and the hope for
participation in family activities, putting special emphasis on the value of fam-
ily relationships. Family time was used to maintain and support relationships;
the parent(s) in these families typically made time for talking and sharing. For
example, although dinnertime was infrequently a regular nightly event for any
family, when families who scored high on the rituality index did sit down to-
gether for dinner, they spent the time talking and sharing, whereas dinnertime in
the families with lower scores might involve everyone sitting down together but
watching television. It appeared that the planned nature of family time spent on
relationship building and maintenance made all family members feel special and
connected.
Another important aspect of this relationship dimension involved extended
family members. In most of the 41 families, relationships with relatives not living
with the family were highly valued and, indeed, often important in many aspects
of the family’s well being, including, at times, financial. Rather than acting as
independent nuclear family units surviving on their own resources, the majority of
the families interviewed in both samples drew upon resources from the extended
family and, in turn, provided resources to those relatives when they were needed.
However, extended family ties among the non-clinical families were described, by
both the adults and adolescents, in particularly positive terms with regard to both
the regularity of contact and the positive feelings about time spent together. One
adolescent described her grandfather as being the most important member of the
family who did not live in the home. The grandfather held particular importance
for the equilibrium of the family “because he stabilizes us. He helps us. He was
there for us when we needed him, when my momma couldn’t do it. He’s there for
me. He’s always been there for me. He’s like my dad.”
Family rituals observances inclusive of extended kin or close friends build
extended networks. When members of the extended family take on a vital role in
the daily life of the family, it can provide the extra assurance that children need
that they are being looked after and, if need be, cared for when difficulties in
life arise. Families that maintain high quality relationships, with both immediate
and extended family members increase the amount of social capital available
and their ability to use such relationship resources for family problem solving.
Strengthening family rituals may be one means of fostering those key protective
relationships between an adolescent and at least one significant adult (Halle &
Moore, 1998).
Successful family problem solving was also described in the context of family
ritual life. One mother and daughter described their problem solving style as a
family discussion with everyone seated around the table. The adolescent described
it this way, “Well, we sit down at the family table and we pray first. Then, we bring
up the problem and discuss it and get everyone’s point of view and decide from
there.”
Family Ritual and Routine 369

The fact that clinical families would differ from non-clinical families on
the relational dimension of family rituals is not surprising. Multiple theories
suggest why. These theories view problems as created or maintained by relational
patterns and structures within the family or by the way emotions are organized
and processed through patterns of family interaction or engagement (Sabetelli
& Bartle, 1995). Families who develop and maintain successful strategies for
the family’s managing relational structures and emotional climate promote the
well-being of all family members. Many of these strategies are related to this
relationship dimension of family rituals, such as, nurturing family togetherness,
and problem-solving for managing conflicts.
The issue of causality is important although well beyond the scope of this
study. Thus, it remains unclear whether the relational differences underlying the
family rituals of these two samples are part of the cause or partly a result of
the adolescents’ behavior and emotional difficulties. Establishing precedence, a
condition necessary for labeling family rituals a risk or protective mechanism,
remains a goal for future studies (Kraemer et al., 1997).
Several limitations of this study must also be mentioned. The sample size for
this study was relatively small, and this restricts the types of analyses that can be
done and the ability to generalize the results. Additional studies of clinical and
non-clinical samples are needed to confirm these findings. In addition, findings
with regard to family ritual functioning were based exclusively on interview data.
Reducing and quantifying the large amount of qualitative information collected in
semi-structured interviews for analysis is difficult at best. However, the fact that
we conducted interviews with both a parent and the adolescent strengthens the
utility of this data.
Overall, this study replicates the finding that ritual practices provide one way
that families maintain their health, and the health of their individual members
(Braithwaite et al., 1998; Bush & Pargament, 1997; Markson & Fiese, 2000;
Viere, 2001). The importance of this finding is that the practice of family ritual
and routine can be conceptualized as a vehicle for creating and sustaining change
in the family and for improving child adjustment (Fiese, 1997, 1993; Imber-Black,
1988; Markson & Fiese, 2000; van der Hart et al., 1989; Wolin et al., 1988).
Our results suggest increased complexity in the relationship between family
rituals and child well-being. The dimensions of family ritual life shown to be
significantly related to the functioning of children in previous studies–such as
deliberateness, structure, or meaning–did not appear to be the critical elements of
family ritual observance related to child clinical status in the current study. Rather,
the relational dimension appeared to explain more of the difference between these
clinical and non-clinical families. One hypothesis to explain this dissimilarity
in results is the potential salience of the disruptiveness of problem drinking on
deliberate planning in alcoholic families versus the dysfunctional quality of rela-
tionships in the families of disturbed adolescents. However, if the dimensions of
370 Kiser, Bennett, Heston, and Paavola

family ritual life are sensitive to disease-specific characteristics, this will have ma-
jor implications for the development of interventions targeting family rituals. We
believe that developing a solid understanding of the unique aspects of family ritual
life will improve our ability to understand its protective function and to develop
and implement interventions designed to strengthen the family’s constructive use
of ritual and routine.
Finally, this study makes a methodological contribution to the extant literature
on family rituals. By using a clinical sample that includes many African-American
families we have begun to address a limitation of the previous work on family
rituals that has involved mainly non-clinical samples and few ethnic minorities.

ACKNOWLEDGMENTS

This study was funded through the Plough Foundation, Memphis. We would
also like to acknowledge the contributions of Mark Sauser, LCSW, Ewa Ostoja,
Ph.D., Sarah Jane Brubaker, Ph.D., Jamie Russell, Deborah Gibson, and Jennifer
Grannan.

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