The assessment of missionaries tends to focus on the adult members of the family unit being approved for service. Yet, the family is the one consistent relational network that missionaries are connected to throughout the prefield, on the field, and post-field phases of mission service. In addition, throughout the history of missions sending bodies have struggled to balance the needs of the missions context, the ministry gifts that the adult members of the family bring to the field, and the dynamics of their marital and family relationships. While the literature on missionary children has grown significantly, adopting a perspective that prioritizes the family unit as the unit being "sent" may result in helpful information regarding missionary attrition and longevity. Therefore, assessing missionary families, not only the individual members of the family, at the various stages of missionary service is warranted. Using concepts and techniques from systems theory, a model and logistical factors for assessing missionary families are presented, along with suggestions for whom to assess, what to assess, and how to conduct family assessment. Resources and possible assessment techniques are also provided.

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One of the long-standing tensions in the mental health professions is between focusing on the health and pathology of individuals, versus focusing on the relational contexts that exist between people. This same tension exists in the task of the psychological assessment of missionaries. Is this person healthy and a good fit for international service, or do they have the relational networks of connection and support to sustain and thrive in cross-cultural service?

Since psychologists have historically emphasized formal assessment procedures, the bulk of the literature and available assessment instruments assume an individual focus regarding intelligence, personality, learning, behavior, values, abilities, and career. This article will challenge this tendency in the field and suggest that a more systemic emphasis may be helpful, particularly in the assessment of missionaries and their families.

In recent decades, mission organizations have embraced the value of assessment, and recommendations for appropriate and ethical uses of assessment, while also exploring potential misuses (Hall & Sweatman, 2002). However, the focus has been on individual and marital assessment, with little attention given to family and social system assessment.

It is important to note that the individual focus is both societally and theologically defendable. In Western society, the emphasis on individual well-being and achievement is extensively documented (e.g., Cushman, 1996; and in the church, Rah, 2009). The Protestant, evangelical belief system--the emphasis of many mission agencies and supporting churches--has been on individual salvation and discipleship (e.g., Ezek. 18:20; John 6:47). In contrast, the corporate perspective of the church as the body of Christ is downplayed. This systemic perspective, both in terms of theological and biblical support, is discussed in depth elsewhere (e.g., Balswick & Balswick, 2007; Grenz, 1998). Suffice it to say, psychologically, theologically, and culturally, the prevailing bias in mission organizations is towards individual assessment.

Individual assessment is valuable and often systemic issues can be identified in well-done assessments. However, the complexity of contemporary family structures (see McGoldrick, Preto, & Carter, 2015) suggests that family assessment may be increasingly needed. For instance, what if a couple chooses to serve but they have had a conflictual marriage regarding the roles in their relationship? Likely the most powerful factor in the effectiveness of a missionary couple will be the involvement and mutual support of one's spouse. What if the couple has children? To what degree will family members aid or detract from missionary effectiveness? For the single missionary, will his or her success and sustainability on the field be connected to his or her relational networks? Other scenarios must also be considered: What if first-time missionaries applying for service are a middle-aged couple with adolescents? What if the wife's mother lives with them and would like to be a part of her family's international ministry experience? What about adoptive families, stepfamilies, multigenerational families, and bi-racial families? What if a couple has younger brothers or sisters living with them? What if grandparents are raising their grandson and desire to serve?

In previous generations it was typical to only accept singles and those in traditional nuclear families for cross-cultural service. However, with the radical changes in family structures in North America and in churches (e.g., single moms, remarried couples and step families) there will be increasing pressure on churches and agencies to send families with nontraditional structures. Putting even further pressure on agencies is the overall decline in the number of new long-term missionary recruits (see Hay, Lim, Blocher, & Hay, 2007; Smietana, 2015; Taylor, 1997, 2002; and World Evangelical Alliance, 2003). With our missionary mandate and the desire to keep the missionary force strong, can agencies limit their approval, funding, and support to traditional families and singles?

Likely, agency reactions such as "we can't afford to alter our application process," or "logistically it would be a nightmare," or "we don't have the staff to do something different," will not suffice as we move into the future. However, more than any other factor, what hinders the adoption of a family lens, including family assessment and supportive family member care resources, is the strong belief that ultimately, if the individuals are healthy and fit for service, the marriage and family will be as well. Therefore, we do not need to complicate the process with attention to couple, family and social system dynamics. However, these assumptions are not necessarily valid.

This raises the broader question of the unique value of adopting a more systemic lens to thinking about missionary personnel. The core concept underlying a systemic approach to assessment is that the relationship between the parts of a family is at least, if not more, significant than focusing exclusively on what is happening within the individuals. In this sense, what is happening between people is more important than why it is happening.

How Important are "Family Issues" in Missions?

Throughout the history of the missionary movement there have been many biographies written about missionary families, and in the past two decades a number of book chapters and articles have been written regarding the issues missionary families face. However, the missionary family has not been a priority in the recruitment, preparation, and support of missionary families.

Recently, the family lens is increasingly being appreciated as an important dynamic in missionary life and effectiveness; there is evidence of a shift toward acknowledging the significance of missionary families within the overall missionary enterprise. The publication of books such as Andrews (2004), Baker & Priest (2014), Bonk (2013), and Hervey (2014) along with website resources such as Families in Global Transition (FIGT; www.figt.org), suggests that the missionary family is worthy of attention by missionary agencies and personnel. In addition, the burgeoning literature on missionary children (MKs--missionary kids, or TCKs--third-culture or trans-cultural kids) sparked by Pollock and Van Reken's (2009) classic book and what we now know of the ways in which missionary children have been abused (e.g., Zylstra, 2014), add to the significance of this perspective.

The ReMAP survey on missionary attrition (Brierley, 1997) found that marriage and family issues were the third overall reason for missionaries leaving their mission (see Table 1). The international business literature claims that about 30% of managers from the U.S. return home early from overseas assignments due to personal and family stress (Pollock & Van Reken, 2009).

These causes can be expanded to include many other "reasons" that are aggravated by the stress that missionary families inevitably experience. Complex family structures, difficulties with special needs children, lengthening family lifecycles, complex gender roles, financial stress, unstable families-of-origin, not being deeply discipled in a Christian worldview and lifestyle, and weaker vocational calling all potentially have significant family implications.

The Need for Family Assessment

There are a variety of reasons why family assessment is necessary for missionaries preparing to go into the field. For instance, fitness of placement, retention factors, and potential hindrances in ministry could be evaluated through family assessment. I remember my parents (missionaries to Japan and Kenya) describing a missionary who was called to the field, but who did not believe that mission policies and procedures, let alone pre-field assessment, were necessary. He believed his personal call to missions trumped anything a mission board might say. These "lone ranger" or "prophet/ apostle" types stand in contrast to a mission philosophy that believes that missionaries are sent by a community and are accountable to a community (the church).

Assessment is part of the broader process of confirming a call to service. Family assessment can confirm or demonstrate the inadvisability of a couple's or family's call to cross-cultural service. It allows the decision to "go" (Mk. 16:15) to be a discernment process that involves essential community elements (e.g., Acts 1; 2 Cor. 8:19). It provides extensive information to a sending organization near the beginning of the missionary journey, which can later on lead to important insights for helping a missionary family in times of distress.

Related to the community perspective of calling, another difficult scenario is the missionary couple who believes that they were given their children by God and therefore they alone should determine all aspects of their children's education, medical care, etc. What right does a mission agency have to interfere in the functioning of their family? The idea that children are temporarily given to families, and within the context of Christian community, are responsible to raise them, is lacking in some Christian families.

Similarly, if donors will be supporting a missionary family with tens of thousands of dollars per year, do the donors have the right to know if this is a healthy family?

Furthermore, if the Gospel matters above all else, then as we "export" the gospel what are we exporting with it? The history of missions includes stories of ministries being harmed due to how the missionary's family functioned, as well as stories of how the national church grew despite the witness of the missionary's family. Thankfully God's work is sometimes accomplished despite us. I continue to be struck by the family struggles experienced by William Carey and his family chronicled in James Beck's (1992) biography of Dorothy Carey. In the missions literature we read much about William Carey, the "father" of the modern missionary movement, but little about his family.

Ultimately, if stress (transition, cultural, etc.) is a chronic, global experience for missionary families (cf., Carter, 1999; Chester, 1983; Cousineau, Hall, Rosik, & Hall, 2007; Foyle, 1987, 1988; Sweatman, 1999) do we as senders have a responsibility to help families develop healthy coping mechanisms even before they go? In a sense, we are preparing, not only individuals but families, for battle (Eph. 6). Spiritual warfare, in many forms, confronts the already stressed missionary family.

Family assessment helps the organization not to miss important areas of concern which may not be self-or other-reported. It provides a baseline to measure change and growth over the years (and the transitions) ahead. Ultimately, it is usually a cost-saving and time-effective intervention.

Family Development as the Guiding Theme

The family development lens is a useful clinical tool for any work with families, and the missionary family is a particularly challenging example of potentially clashing developmental stages and trajectories (see Figure 1). The individual psychosocial development of each member of the family overlaps with what we know about common stages of family development (e.g., marriage, birth of first child, adolescence, "empty nest"), which together overlap with the typical stages of missionary family life (e.g., recruitment, pre-field, home assignment, permanent return to home country, crisis debriefing).

It is not uncommon for developmental tensions, or even clashes, to occur when, for instance, a mid-life couple committed to long term missionary service, but in the midst of re-thinking their missions strategy, is dealing with adolescent children who are in their own complicated identity development process as TCKs. I described in detail such a family in a case study based on a compilation of several missionary families with whom I have worked (Gingrich, 2002).

Family assessment can be valuable at several points in a family's life and missionary career, particularly at pre-deployment, mid-term, times of crisis (either external or internal), significant family transition times, and end of term/service and repatriation (chosen versus mandated). Individual developmental transitions (e.g., a child leaving home) or crises (traumatic experience) are also an opportunity to assess not only the individual but the impact on the whole family.

Who to Assess

Individual assessment of the adults in the family is common. However, less common is the individual assessment of children and adolescents. A common question is whether babies, toddlers and elementary-age children should be part of any assessment process. Family therapists also struggle with this question, but I believe the major obstacle to including younger members of the family is the assessor's comfort with managing the multiple family members and unique relational dynamics in the room at the same time (see Figure 2). One should not assume that one will be able to become comfortable with all family members together in a room, yet it should not be avoided. Friedman's (1985) oft-quoted advice for the family therapist to be a "nonanxious" presence with the family is easier said than done, but it is a goal to pursue.

In family systems approaches, it is acknowledged that while the whole family can benefit from meeting together, the couple subsystem is often the most influential part of the family. Thus assessing the couple's relationship, in addition to individual and family assessment, should be considered. Various specific marital assessments are available (see Appendix A). Related to, but distinct from couple assessment is the assessment of parenting dynamics. In families, the sibling subsystem is also significant. I remember one missionary sibling subsystem of four sisters ranging in age from seven to 15 that became the focus of treatment, since the parents were not open to exploring their relationship. So, the sisters asked to talk to a counselor together regarding how they could support each other in the presence of what was clearly a tension-filled marital relationship.

If understanding the immediate family dynamics does not already feel overwhelming, a number of family systems approaches (e.g., Bowen, 1978; Hendrix, 2001) pay considerable attention to the couple's families-of-origin (FOO). In contrast, the recent marriage and family therapy literature increasingly appears to have moved away from an emphasis on the FOO. This is based on the belief that current patterns and functioning are not significantly impacted by the FOO, and that creating a safe haven and secure base in one's current relationship can overcome deficits in early family attachment (Johnson, 2004). However, personal and clinical experience, as well as numerous theoretical models of change in relationships, recognize that FOO, while not determinative, is highly influential, and family dynamics are susceptible to generational repetition in the absence of intentional corrective efforts.

What to Assess

The options regarding what to focus on in family assessment overlap considerably with individual and couple assessment of personality, psychopathology, character, spirituality, cultural adaptability, and relationships (marital, romantic, FOO, friendships, organizational/professional). Based in the rich theoretical foundation of family systems approaches, each of the following concepts is relevant to all families (though it is beyond the scope of this article to define them all): relational bonds, boundaries, triangles, subsystems, power (hierarchy), autonomy, commitment, life cycle development, roles in the family, rules, and culture (internal and external). Additional theoretical concepts, based on Olson's model (Olson, Russel, & Sprenkle, 1989), are flexibility/adaptability, cohesion/connectedness, and communication. Relevant to communication are concepts such as listening, clarity of expression, conflict, and conflict management. Specific to missionary assessment, it is helpful to assess the potential for fit with a specific field or culture, fit with a specific mission team, and fit with a specific ministry focus.

Family Patterns.

Extending the concept discussed earlier regarding what happens between family members being more important than what happens within family members, a focus on relationship patterns or dynamics may be the most useful concept in family assessment. Patterns involve aspects such as respect for others, openness to others, separation and loss, emotional variability, mood, empathy level, trust, resiliency, and mutual and external support. Potential (or current) negative relationship patterns such as the frequently-experienced patterns of pursue-distance, attack/criticize-defend, demand-defend/appease, and withdraw-withdraw, are helpful to identify. More complex relational patterns identified in Emotionally-Focused Couples and Family Therapy (e.g., Johnson, et al., 2005) include dynamics such as pursue > attack > placate > withdraw, reactive attack/withdraw, and complex relationship patterns emerging from a history of trauma for any of the family members.

Family assessment touches on all of this, but more directly attends to current family functioning. Given the high stress reported for missionaries, how will this family respond to these external stressors? Ideally, in an assessment process it would be helpful to observe a family interact together (communication focus), work together (task focus), play together (recreational focus), and respond to difficult circumstances together (crisis focus).

The BONES of the family. This model is adapted from the family counseling model presented in Blume (2006). He structures his thinking and work with families around the acronym "BONES" (see Table 2). The five dimensions of this model are essentially themes for both assessment and intervention.

It is noteworthy that spirituality is a major theme in this model. In addition, the classic psychological categories of Affect, Behavior, and Cognition are replaced with family and communication behaviors and skills, emotional dynamics in the family, and the category of family organization or structures. The category of narrative reminds us that every family has individual, couple, multi-generational, extended, and culturally-derived stories that intersect to form the current family dynamics.

Resilience. It may be helpful to take a step back and examine our overarching perspective regarding missionary families. The assessment of missionary families, particularly at the pre-deployment stage, tends to gravitate towards either looking for ill-defined evidence of a healthy family or for an equally ill-defined expression of a dysfunctional family. Those who work with families tend to have an almost intuitive sense of what constitutes each of these poles; in our assessment of families we create a sort of internal balance scale regarding the significance of various factors, which side of the balance they are on, and how much they outweigh other factors on the other side of the balance. It is an inexact process built on valuable experience with families and informed clinical judgment. In missionary family assessment, we want to see healthy families and appoint them to service, and we would like to screen out the dysfunctional families. With the added stress of missionary life, dysfunctional families are more likely to deteriorate under stress and require early repatriation.

However, while there is a need to become more precise about our definitions of the two poles, it is also important to define what the middle might look like--the middle where most families exist. The midpoint between the poles is not defined by a little of this and not too much of that, but by another important concept in the missionary family literature: resilient families. This perspective is briefly summarized in Table 3. Reviewing the characteristics of each type of family produces a nuanced sense of what we may be looking for when assessing families. In our experience we probably have many examples of dysfunctional families and a few good examples of healthy families, but the bulk of the Christian families who apply for missionary service are likely in the resilient family category.

Resilience is a frequently referred to concept in the member care literature and was the theme of the 2009 Mental Health and Missions Conference (www.mti. org/conferences/mental-health-and-missions) where I presented on resilience in missionary families (Gingrich, 2009), using Walsh's model (2006) as a foundation (see Table 4). This framework has helped me direct my focus and organize my observations when with families (see Appendix D for how this can be used as an observation template).

Walsh's model, while on the one hand quite basic (examining belief system, patterns, and communication) expands into very relevant and helpful assessment categories (see Walsh, 2012). For instance, it includes particular attention to spirituality as a key to family resilience. Most, if not all, missionary families will claim that spirituality is both the motivating force behind their desire to serve, and the day-to-day sustenance they depend on to handle missionary life. However, when asked specifically, missionary families may have some difficulty identifying how spirituality helps them as a family deal with the stresses of life together in another culture.

In addition, I appreciate the inclusion in Walsh's model of social and economic resources as a strategic factor in resilience. The social realities of meaningful and sustaining relationships while on the field are often a struggle for missionary family members. Being uprooted from friends and extended family in their home country and being planted in a new country and culture (with nationals and other missionaries to relate to), is more complex than families may realize. In some ways, the most difficult social adjustment families must make is to their fellow team members, who perhaps represent several other countries and cultures.

The economic resources are also challenging. While agency or denominational supported missionaries may be better off financially than in previous generations, the gap between the typical North American life style and missionary living in the majority world is at times quite dramatic. Whether or not support is adequate may not be the most significant question; the issue might be how the family will handle the contrasts between their financial worlds. For instance, the context of poverty on many fields and then on home assignment in Canada being surrounded by relative abundance led me to attempt to explain to my children that in Canada we are relatively poor, but in the Philippines we are rich.

How to Assess

Family assessment utilizes a variety of data-collection methods, which supplement self-report methods, thereby broadening the sources of information and reducing bias (see Table 5 for a summary of assessment modalities). Self-report measures, the standard in psychological assessment, can be used particularly well with families who are open, and articulate. However, the use of standardized assessment instruments, while often helpful for adult individual and couple assessment, has limited usefulness in family assessment that includes children. The use of structured & semi-structured interviews also requires articulate members and privileges older family members.

There is also a vast literature within the marriage and family therapy field regarding informal, non-standardized, creative, and adaptable techniques for family assessment (see Appendix A for examples). Due to the uniqueness of each family, each family member, personality types, and family dynamics; good family assessment typically relies heavily on enactments--structured family tasks--and facilitators who can initiate family activities, make astute clinical observations of family interactions, and use clinical judgment to infer functional and dysfunctional patterns. With whatever method used, assessment is a discernment process in which the assessment team's maturity, training, and wisdom play a key role.

Leveling the playing field. The use of play techniques in child and adult counseling levels the room so that everyone has an equal opportunity to engage. Play therapy for children is a common specialization in the mental health fields and requires a unique set of skills. However, play is not only a child therapy modality, but is applicable and useful for adolescents and adults as well. For instance, the literature on the use of relationship sand tray therapy is a specialized form of play therapy (see Homeyer & Sweeney, 2011, ch. 9).

Landreth (2012) describes the value of child play therapy with the phrase, "toys are used like words by children, and play is their language; toys are their words" (p. 12). Sweeney and Rocha (2000) identify the advantages of play within family therapy as:

* Equalizing the developmental stages among family members;

* Symbolizing many aspects of family life, rather than requiring conceptual/language cognitive and emotional expression; and

* Providing the counselor an unobstructed view of the family emotional climate and dynamics.

These advantages provide a compelling justification for using play therapy techniques within family assessment sessions. For instance, using family teams (demonstrating competition and cooperation), verbal/non-verbal play, and adding limitations and obstacles (e.g., the family is asked to draw a rainbow with each member using a different color marker).

Observing structured family activities. Observing family activities can provide a wealth of data, not unlike the wealth of information obtained from group therapy process observations. The following sample questions will be helpful in focusing one's observations during a family activity:

* Who initiates, has energy and ideas? Who holds back?

* Who takes charge, follows, rebels, disengages?

* What is the tone? (Competitive, cooperative, individual, chaotic, structured, superficial, tense, laissez-faire, etc.)

* During the activity, was there a shift in direction ? Initiated by whom? Sparked by which comment or topic?

* Was the use of space, touch, negation, encouragement, affirmation appropriate?

* What were the overall communication strengths and challenges?

Assessment process guidelines. The following recommendations should be considered in conducting family assessment:

1. Two facilitators (one lead and one in a support role), meet with all members of the family together in one room for a set of activities for a minimum of a half day. The pacing of the time together needs to be carefully monitored both to minimize fatigue and to keep participants engaged. Families typically do not take time-outs or breaks from each other, so pushing the family a little to keep engaging is realistic.

2. The family is guided through several interactive activities as well as discussion and feedback. Again, pacing of activities and discussion is important. Assessment activities must emphasize family member-to-member interaction, not just family member-to-facilitator interaction. It is helpful to video record the time together if possible. Families often balk at this, but if the video is presented as standard practice and with an assurance of confidentiality, most people quickly forget about the recording. A video recording can be a helpful reference when debriefing either with the family or with the other facilitator.

3. The possible types of family assessment activities are extensive (see Appendix A). The choice of particular activities can be matched to the ages of children and other factors, but in a sense the specific activities do not matter as much as the facilitation skills of the assessors.

4. Facilitators should be skilled at intervening in ways that actively engage families, while still knowing when to quickly move into the background to allow the family dynamics to emerge. It is also necessary that facilitators are skilled at intervening to divert a family's attention to other activities or topics, particularly when interactions are becoming tense or one or more member is disengaging.

5. Perhaps the most anxiety-producing and complex part of the process is presenting a summary report with recommendations to the family and to the mission agency. Using some version of a theory-driven outline to guide observations and recommendations can make the process easier. Developing an observation template can help organize the facilitators' thoughts and reactions. A sample based on my own model of couple and family relationships is provided in Appendix B, along with a short primer on the model's key concepts.

6. Carefully consider the pros and cons of various feedback, report, and recommendation strategies (see Appendix C for guidelines). While a template, cookie-cutter format helps with streamlining the process, individual families may benefit from different feedback approaches.

To provide a more concrete progression of steps in family assessment, the following sequence is adapted from Heffer and Snyder (1998):

1. Review referral information.

2. Conduct standardized assessments (e.g., FACES IV, see Appendix A).

3. Interview and conduct family activities with all family members together and observe family interaction.

4. If possible and relevant, gather information from outside the family.

5. Organize and review all data.

6. Integrate data with theoretical perspectives.

7. Develop recommendations.

8. Write the report.

9. Meet with the family for debriefing:

a. Discuss family strengths and challenges;

b. Establish goals with the family and recommend follow-up.

10. Implement recommendations.

11. Offer reassessment and reformulation as able and appropriate.

The Costs and Dangers of Family Assessment

Many agencies include the cost of assessment in the missionary family's fundraising efforts. This can be resented by the family or the donors so the "idea" and benefits of assessment need to be clearly articulated. Paying a mental health professional for their time and materials is a challenge for some. Once they add this to the cost of agency staff related to family assessment and the time it takes to conduct and process the assessment information for the agency and the family, some might feel like it is not worth it for the family or the mission agency. We as care-providers have the job of providing the rationale and expertise to make it worthwhile, but ultimately each mission agency has to do their own cost-benefit analysis.

A few cautions are worth mentioning. Assessment is not treatment; it is not the same as counseling or family therapy. Throughout the history of family therapy, there has been a reluctance to diagnose pathology in individuals or families. Since the goal is not diagnosis, some might question the value of assessment. Furthermore, the experience of undergoing family assessment, in many cases, is not immediately helpful for the family. While family members can benefit from experiencing something new together during the assessment process, and the agency will find it informative in their overall appointment decision, care needs to be taken not to exaggerate the immediate impact. The value of assessment is primarily to provide a current base-line regarding family functioning and insight regarding family dynamics, with a view toward understanding potential developmental challenges.

In addition, assessment is sometimes done in an uncaring, clinical way that might be experienced as diminishing the uniqueness of the person or family and the relationships they have. As with all types of assessment and intervention, the relationship between the professional and the client is of significant value, if not the most valuable part of the experience.

Finally, assessment can provide an overload of irrelevant, or marginally relevant, information, so assessors need to be able to organize and communicate relevant information. It is also a challenge to know what is of most importance clinically and what is extraneous. Overall, assessment can be a perfunctory exercise wasting time, effort, and money, or it can be a rich source of significant information and used for the short- and long-term benefit of the family and the organization.

Three Additional Dynamics to Consider with Missionary Families

While the following three issues may apply to all families, I believe they are particularly relevant to missionary families and are worth including in family assessment.

The birth of the first child. Current research (e.g., Doss, Rhoades, Stanley, & Markman, 2009; Gottman & Gottman, 2007) has identified the time period around the birth of the first child as the most critical developmental time for a marriage. Couples having children show a clear decline--not necessarily large but consistent in the research--in marital quality that is concentrated around the time of childbirth, particularly the birth of the first child. This probably comes as no surprise to most parents, but our society does not give permission to young families to acknowledge this. This developmental adjustment needs to be taken seriously. Couples are somewhat more at risk if their first born is a girl, since it is suspected that fathers are more involved if the first child is a boy (Gottman & Gottman, 2007).

In my own family's experience, this developmental transition was particularly stressful. My missionary parents left for Japan in 1954 when my mother was six months pregnant with my sister. This was less than 10 years after the devastation experienced in the aftermath of the atomic bombs that led to the end of WWII. Japan was a shattered country, and the North American perception was that it would be wide open to the Gospel. Many singles and young couples, some with families, were deployed based on their calling and not necessarily on their fitness for service in what is one of the most difficult mission fields in the history of the missionary movement.

Note that during this time in the history of missions, due to the sense of critical need and the post-war optimism of the West, this scenario was not uncommon. However, I would hope that in the contemporary mission recruitment and deployment strategies that this would be an unlikely scenario today. Family assessment could have identified and helped everyone involved make better informed decisions.

Family culture. The second issue that is crucial in missionary family assessment is the need to intentionally address the culture of the family, the mission agency, and the host culture. More than ever in our culturally-sensitive global context, respecting diversity both within the family and between the family and the context of service is required. This issue accounts for a substantial amount of the transition stress both at the time of deployment and re-deployment. Again, this was experienced in my family's history. As Canadians, my parents were appointed to a field, Japan, under the auspices of an American mission, and three years following our initial five-year term in Japan, due to organizational changes within the North American mission agencies, we were re-deployed to Kenya. The cultural transitions were massively disruptive to our family--involving North American cultural differences and transitions to both an Asian and African culture within an eight year period.

A related dynamic is the more recent trend of families working on multicultural teams on the field. Home culture, host culture, and the culture of other team members have a powerful impact on a family's functioning. Furthermore, all cultures have embedded within them a wide range of family life variations.

Family spirituality. The expectations from others, church, extended family, and even the culture at large, is that missionaries and missionary families should be paragons of mental and spiritual health. Like the PK (Pastor's Kid) phenomenon, the expectations for MKs/TCKs are hard to live up to. Only 17.5% of MKs become missionaries themselves (Pollock, 1997, p. 305), but with their rich, cross-cultural, and international experiences, shouldn't we work towards increasing that number?

It is difficult to assess spirituality, within the confusing spiritual context of North America culture, in age-appropriate ways. It is also difficult to have potential missionaries or experienced missionaries talk about spirituality without the "learned-in-church" jargon, or the "learned-in-seminary" doctrinal emphasis. Purpose, meaning, faith, beliefs, grace, suffering, forgiveness, serving, meaning in adversity, transcendence, resilience, as well as formal religious involvement are all important.

Conclusion

Helping a family to talk about their anticipated transitions is one time when assessment begins to look like therapy. Family therapy is in some ways simply an extension of family assessment in which a family is led through new experiences, new conversations, and new emotional interactions in the hopes that within the new experiences, old patterns can be shifted and new patterns initiated.

An article like this can easily provoke more questions than it provides answers. It promotes an understanding of families and suggests interventions a little outside of the comfort zone of even experienced mental health professionals. At the very least I hope it provokes some questions both about the involvement of families in the missionary endeavor and the inclusion of families in the process of determining calling and fit. My recommendation is that mission agencies include attention to the family as a whole, not only the individual's mental health, the marital relationship, parenting, spirituality, and cross-cultural adaptability.

It is my hope that with careful attention being paid to missionary families, the crucial questions of calling, faith families, the missionary enterprise, and the family as witness to the Kingdom will become a clearer and a more compelling challenge to those who serve and those who support and pray for missionary families.

Fred C. Gingrich

Denver Seminary

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Author Note: This article is adapted from a presentation given at the Mental Health and Missions conference, Nov. 22,2013, Angola, IN.

Correspondence regarding this article can be directed to Fred Gingrich, Denver Seminary, 6399 S. Santa Fe Drive, Littleton, CO 80120. Email: fred.gingrich@denverseminary.edu

Author Information

GINGRICH, FRED C. DMin. Address: Denver Seminary, 6399 S. Santa Fe Drive, Littleton, CO 80120. Email: fred.gingrich@ denverseminary.edu Title: Professor of Counseling. Degrees: BA (Psychology, Philosophy), Carleton University, Ottawa Canada; MA (Individual and Marital Counseli ng) St. Paul University, Ottawa, Canada; DMin (Marriage & Family), Palmer Seminary, Philadelphia, PA. Specializations: Global Mental Health, Marriage and Family Therapy, Integration.

APPENDIX A

A Sampling of Family Assessment Resources

This is by no means an exhaustive list of family interventions and techniques. For further suggestions, the following resources may be helpful: Berghuis & Jongsma, 2004; Casado, Young, & Rasmus, 2002; Dattilio & Jongsma, 2000; Edwards, 2011; Hazell, 2006; Heffer & Snyder, 1998; Hervey, 2012; Hodge, 2005; Minuchin & Fishman, 1981; Nelson & Trepper, 1993; Richardson, 1987; Satir & Baldwin, 1983; Sherman & Fredman, 1986; Sperry, 2011; Thomlison, 2009; Watts, 2000; and Williams, Edwards, Patterson, & Chamow, 2011.

Formal Family Assessments

(For a thorough review of formal family assessments see Lebow & Stroud, 2012)

1. Family Assessment Device (Epstein, Baldwin, & Bishop, 1983).

2. Family Assessment Measure (Skinner, Steinhauer, & Santa-Barbara, 1983).

3. Family Environment Scale (Moos, 1990).

4. Family Functioning Style Scale (Trivette, Dunst, Deal, Hamer, & Propst, 1990).

5. Revised Inventory of Parent Attachment (Johnson, Ketring, & Abshire, 2003).

6. Family Adaptability and Cohesion Scales (FACES IV) (Olson, 2011; Olson, Gorall, & Tiesel, 2007). Includes identifying family type and the dimensions of Openness (flexibility), Intimacy (closeness), Communication, and Satisfaction. Consists of 62 questions, and each family member over the age of 12 is asked to complete it. FACES IV can be adapted as interview questions: For example:

--How do you spend time together as a family?

--When you have a problem, who in the family do you talk to? How do they respond to you and the problem?

--How often do friends and extended family visit your home?

--How do family members respond when there is a change in plans or routines?

--What are some of the basic rules in your family?

- Who makes the major decision in the family? How are these decisions communicated to the family? (Williams et al., 2011, p. 152).

Formal Parenting Assessments

Parenting assessment is usually done through self-report questionnaires, which may be more or less accurate due to social desirability (the desire to look good to the assessors). Many parenting assessments are available; a few are included here:

1. Parenting Stress Index (and variations; available from PAR; www.parinc.com).

2. Early Childhood Parenting Skills (available from PAR; www.parinc.com).

3. Parenting Alliance Measure (available from PAR; www.parinc.com).

Such assessments can be included in the family assessment, or they can be part of the components of the interview and/or observational exercises given to the family. At some point, be sure to ask about the use of discipline techniques (specifically, spanking). In some countries, physical discipline is illegal, in some countries it is culturally inappropriate, and in some it is culturally expected as a sign of good parenting. Cross-cultural differences in parenting are highly significant, and awareness of parenting styles in specific countries is recommended. Even well-experienced parents can benefit from an opportunity to learn additional or alternative parenting techniques.

Formal Marital Assessments

Again, many instruments are available. Three well-known, well-researched instruments that provide helpful feedback to couples are:

1. Marital Satisfaction Inventory, Revised (available from PAR; www.parinc.com)

2. Life Innovations (www.lifeinnovations.com) offers the very well-researched, well-designed, and user-friendly Prepare/Enrich set of customized questionnaires that can be completed online and debriefed with a certified facilitator. The Prepare inventory, for premarital couples, is expanded in the Enrich version to include sections for couples with children in step-families and re-marriage situations or foster and adoption families. Prepare/Enrich also offers a shorter version called Couple Check-up, which is ideal for marriage enrichment groups.

Drawing and Writing Family Activities

1. Genograms (McGoldrick, Gerson, & Petry, 2008) are a data gathering tool particularly useful in illustrating complex family structures and complex families-of-origin. They can be used to explore specific issues such as dysfunctional triangles, addictive patterns, abuse, or even spiritual heritage. A genogram using triangles (Marlin, 1989), spiritual genograms (Frame, 2000), and money (Mumford & Weeks, 2003) are three of many variations.

2. Eco-maps (www.strongbonds.jss.org.au/workers/cultures/ecomaps.html) and sociogrants (http://infiressources.ca/fer/Depotdocument_anglais/The_sociogram.pdf) are visual depictions of family relationship networks. They serve to reveal and analyze the relationships of a person within their family or social circle, or to visualize the relationships within the family, or of certain members of the family with their external environment, such as friends, extended family, health and education services, leisure time activities, and work. In some ways this is similar to Minuchin and Fishman's (1981) family map.

3. Family Picture: Each family member is asked to draw (without analyzing and without comparing) how they see the family. Encourage creativity; provide a variety of media. Each member shares reflections on what the picture says about their perception of their family.

4. History of our Family (nodal history/time line): Together identify "nodes" (memorable, meaningful moments or episodes in your family story. Include both good and bad experiences. Use a visual graphic (e.g., time line) and ask the one who mentions an event to choose a symbol or put it on the time line. Begin with asking kids about birthdays and special events for them (e.g., a vacation, a sickness, a move, a new school, death of grandparent). Fill in the gaps with contributions from older members. Ask specifically about deaths, illnesses, celebrations, surprises (crises), miscarriages, employment, and school transitions. Note things such as, who adds what? Who identifies the normal and not-so-normal developmental markers and responses to change? Notice emotionally meaningful comments such as "when my friend Julie moved in down the street." Are there any "emotional shock waves" (emotionally laden events that have ripple effects through the family history)?

5. The Family 10 Commandments-. All families have rules. Some are explicit, many are unspoken, yet understood. Identifying these spoken and unspoken rules can help us to know ourselves better and can give insight into the origin of some of our values, conflicts, inconsistencies, preferences, and interpersonal styles. Explore family rules regarding topics such as money, education and success, God, church, spirituality, hospitality, roles of men and women, marriage, in-laws, extended family, eating, alcohol and drugs, complimenting and praising, sex, showing affection, expressing anger, children, and physical punishment.

6. Examples of other family activities that can be used for assessment: Family Art Project, Family Play Time, Family Building Project, Family Doll House, Family Puppet Show, Family Sand Tray (Ffomeyer & Sweeney, 2011). Virginia Satir, the "grandmother of family therapy," describes numerous creative techniques (Satir & Baldwin, 1983) such as the use of ropes and Parts Party.

Specific Missionary Family Activities/Questions:

1. Favorite home assignment (furlough) activity?

2. Favorite family photograph from [country]?

3. Stories, music, food, letter writing, etc. from [country]?

4. Describing transition(s).

5. Losses?

6. Opinions about relocation?

7. Children's response to the idea of leaving North America (emotional expression and behavioral reactions) ?

8. Alternatives to leaving?

9. Levels of support before, during, and after transitions?

10. A variation on "The Miracle Question" (de Shazer, 1988): "Suppose that one night soon, while you were asleep, there is a miracle, and you wake up in your bedrooms in your new (to you) house in [town/city/ country]. However, because you are asleep you don't know that the miracle has already happened. When you wake up in the morning, what will be different that will tell you the miracle has taken place? What else?"

11. Exploring the family's broader networks:

--Families of origin

--Church/community support base

--Friendships

--Crisis relational support

--Crisis financial support

--On-field crisis support

Every family being assessed for international service needs to be asked the question: "If your family has a serious crisis, where will you go 'home' to?"

12. Stress assessment: "The last thing we will do today"

At the end of the assessment time, everyone is tired and "done," but this is when you are best able to assess stress tolerance. Give the family a very difficult, almost impossible interactive task to do as a family. This is not to be cruel, but to see how they interact under stress. Remember, anything you ask them to do is much less stressful than what they will experience numerous times on the field. Be sure to debrief the experience well.

APPENDIX B

An Assessment Template Based on the 3D Model of Relationships

TABLE 6

The 3D Family Assessment Checklist (Fred Gingrich [c] 2013).

Dimensions                      Score: 1 (low)-5 (high)   Observations

DEVELOPING SKILLS--Communication

Expressing

Listening

Decision-making (negotiating)

Gender roles

Power (control, authority)

Conflict

Forgiveness
(practicing grace)

Openness to change,
adaptability/flexibility

DEEPENING INTIMACY--Attachment

Intimacy (emotional bond,
love)

Knowing the other

Commitment ("for better or
worse")

Self-sacrifice (self-giving
service to others)

Loyalty

Sexuality (affection, touch,
"naked and unashamed")

DEFINING SELF--Differentiation

Family of origin (history,
legacies)

Knowing self (uniqueness,
personality, talents,
potentiality)

Boundaries (where do I
end and others begin)

Releasing each other
(letting go, launching)

Expectations (what I, you,
we hoped for)

APPENDIX C

Guidelines for Report Writing: Compilation, Recommendations and Debriefing

The following guidelines are an initial effort to share experiences of family assessment that I hope will generate further development by others.

* Make the overall assessment experience as positive an experience as possible for the whole family

* Use creativity--make it fun

* Focus on strengths, growth, potential, and resilience rather than just problems

* Each observer should write their own observations before meeting with other observers to compare observations and compile a formal report.

* Reports need to include useful and actionable observations and information; they do not need to be so highly detailed that major points and recommendations get lost.

* Reports should identify family strengths as well as concerns and recommendations.

* Ideally, though logistics often interfere, the facilitators should have a debriefing meeting with the family (in person) prior to the completion and submission of the report to the agency.

* Adolescents and children should be equal participants in the debrief and feedback process, and their voices solicited and considered.

* Major recommendations should be reviewed with the family and their responses noted and considered. Most feedback should be given to the whole family, since the whole family was included in the assessment.

* If substantial concerns are observed, specific examples should be used to illustrate concerns.

* Opportunity should be given for the family to respond, either immediately or after a period of days to reflect.

* Examples of recommendations to consider depending on the family and observations:

** Eat at least one meal per day together. Research has clearly demonstrated the importance of daily family meals (www.thefamilydinnerproject.org; Musick & Meier, 2012).

** Quality time does not replace quantity time--structure family time daily, weekly, quarterly

** Develop family support networks in home country and on the field

** Financial advising

** Educational consultant

** Adolescent coach--pre-field and/or on the field (someone outside the family who comes alongside the teen as a transition guide)

** Marriage and family information (e.g seminars, reading, etc.)

** Marriage mentor or family mentors

** Parenting training or parenting coach

** Marriage enrichment (preferably more than a Friday night and Saturday morning large group event)

** Marriage, family, individual counseling

** Spiritual direction

APPENDIX D

Assessing Resiliency in Missionary Families

TABLE 7 Score Card for Assessing Resiliency in Missionary
Families (adaptedfrom Walsh, 2006, 2012).

Resiliency Processes                       Score: 1       Unique issues
                                       (low) -10 (high)    for family

FAMILY BELIEF SYSTEMS

Making meaning of adversity
Positive outlook
Transcendence and spirituality

ORGANIZATIONAL PATTERNS

Flexibility
Connectedness
Social and economic resources

COMMUNICATION PROCESSES

Clarity--clear, consistent messages
Open emotional expression
Collaborative problem solving

Note: This can be used as a handout with a family, but
likely children will not be able to contribute significantly
to the family task of completing it. It may be better
utilized by facilitators to summarize a particular family's
resiliency strengths.

TABLE 1

Causes and percentages of missionary attrition due
to "family reasons" (Brierley, 1997, p. 92).

Reason                      NSC    OSC    Overall

Children                    4.8   10.1       8.1
Health problems             5.1    8.4       7.2
Personal concerns           4.5    5.2       4.9
Elderly parents             1.3    3.8       2.9
Outside marriage            4.0    3.4       3.6
Marriage/family conflict    2.8    3.6       3.3
Total                      22.5   34.5      30.0

Note: "NSC" and "OSC" refer to newer sending countries
(e.g., Korea, Philippines, or Brazil) and older sending countries
(e.g., USA, Britain, or Germany).

TABLE 2

The BONES of the Family (adaptedfrom Blume, 2006).

                             Family                  Narrative
Behaviors                 Organization          (the family stories)

* Skills             * Differentiation        * Identity
* Knowledge          * Family structures      * Scripts
* Communication &    * Family functions       * Dominant & alternative
  conflict           * Inter-generational       stories
* Reactivity &         patterns               * Co-created stories
  responsiveness     * Systemic patterns      * Culture/ethno-
                     * Developmental stages     sensitivity

       Emotional
        Dynamics               Spirituality

* Attachment/ connection   * Meaning/ purpose
* Internal experience        in life
* Emotional expression     * Beliefs/themes
* Empathy                  * Religious practices
* Emotional intelligence   * Moral compass
* Affect regulation

TABLE 3

Contrast between Healthy, Dysfunctional and
Resilient Families.

                                                 Dysfunctional
Healthy families         Resilient families      families

Minimal problems         Have had, or            Problem-saturated
(minor, transient)       currently have,
                         trauma and/or
                         challenges

Normal behavior and      Bounce-back ability;    Stuck in unhealthy
development              adaptability            patterns

Characteristics such     Strengths-focused,      Diagnosable;
as loving, fun,          yet working on          symptomatic
committed, child-        challenges
attentive, etc.

Appear to                Have relational         Never seem to respond
automatically respond    processes that work     to positive ways
correctly to all         toward resolution and
stressors                growth

Model, ideal             Hopeful                 Need to be fixed;
                                                 need therapy

The family to emulate    The realistic family    The family to avoid

TABLE 4

A Model of Family Resilience (Walsh, 2006,
p. 131; Walsh, 2012, p. 406).

Family belief systems            * Making meaning of adversity
                                 * Positive outlook
                                 * Transcendence and spirituality

Organizational patterns          * Flexibility
                                 * Connectedness
                                 * Social and economic resources

Communication/Problem solving    * Clarity--clear, consistent messages
                                 * Open, emotional expression
                                 * Collaborative problem solving

TABLE 5 Examples of Sources of Assessment Information.

Formal                         Informal

* Self-report (application,    * Family activities
  data collection)               (observations)
* Other-report (references,    * Conversations
  observations)
* Psychological testing        * Interactions with
* Interviews                     mission
                                 agency personnel