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Social Support

THEORY, RESEARCH, AND INTERVENTION

Alan Vaux

PRAEGER New York Westport, Connecticut London

ISBN 0-275-92811-X Copyright 1988 by Alan Vaux First published in 1988 Praeger Publishers, One Madison Avenue, New York, NY 10010 A division of Greenwood Press, Inc. Printed in the United States of America

1 CONCEPTUALIZING SOCIAL SUPPORT You are the wind beneath my wings. Henley and Silbar 1 The line above from a popular ballad might apply equally to all our "loved ones." As such, it captures in a subtle but powerful image the role that social support plays in our lives. Our family and closed friends, mentors and workmates, acquaintances and neighbors are always there -- a social medium through which we pass. Like the wind, their presence is so ordinary as often to go unnoticed. Yet like the wind beneath a bird's wings, they are an essential part of our flight -holding us up, carrying us along, providing life, allowing us to soar and to glide, giving us location and identity, guiding our movement, and buffeting us into action. Social support has to do with everyday things --sharing tasks and feelings, exchanging information and affection -as well as dramatic but common human experiences -- the joy of love, the pain of isolation, family ties, and bonds of friendship. The idea underlying social support is both commonplace and immensely rich. Therein lie both the appeal and promise of the construct and the obstacles to its systematic study. THE ROOTS OF INTEREST IN SOCIAL SUPPORT One of the earliest works of modern sociology, conducted almost a century ago, concerned the crucial importance of social ties. In his classic study of suicide, Durkheim (1897/ 1951) highlighted the etiological significance of diminished social ties -- to family, community, and church -- and of the corresponding dissolution of clear social roles and norms, arguing that the resulting state of anomie led to suicide. Indeed, performing the first substantial analysis of social epidemiological data, Durkheim found that suicide was most prevalent among those groups with the weakest ties. Social disintegration attendant upon industrialization and urbanization persisted as a common theme in European and U.S. sociology through the first part of this century. The face-to-face, multidimensional, and personal relationships characteristic of rural village life were contrasted with the impersonal, specialized, and formal relationships thought to dominate urban life (Simmel 1902/ 1950). The dramatic disruptions in the social life of Polish peasants who migrated from rural villages to large U. S. cities where documented by Thomas and Znaniecki (1920/ 1950), for example. The view that disrupted social ties led to psychological and social problems was perpetuated in the "Chicago School" of sociology by Roberts Park, Ernest Burgess, and Roderick McKenzie, who examined the spatial distribution of disorder in Chicago (Catalano 1979). Although contemporary sociologists are less inclined to point to urbanization and industrialization as great evils and generally take a more complex view of ecological findings that link social disintegration to psychological disorder, the work briefly outlined here set the stage, not just for social epidemiology in general, but for work on social; support specifically. In particular, the idea that morale and well-being are sustained through primary group ties, the absence of which may result in a loss of identity, confusion regarding norms, and despair, echoes in contemporary discussions of social support. Social relationship early in life feature prominently in many theories of psychological development. Bowlby (1969), for example, noted the importance of attachment behaviors -- looking, smiling, vocalizing, and later, following, and clinging -- that begin to emerge in the second half of an infant's first year and that serve to maintain contact with the primary caregiver, usually the mother. Bowlby
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Larry Henley and Jeff Silbar. "The Wing Beneath My Wings." Copyright 1982. Warner House of Music & WB Gold Music. All rights reserved. Used by permission.

(1969) recognized the evolutionary significance of attachment, allowing exploration while offering protection to vulnerable young. The concept has been developed, and attachment is seen as playing a key in development. The securely attached infants has s reliable base from which he or she can explore and learn about the environment and to which he or she can return when events become too threatening (Ainsworth 1979). Yet, secure attachment is not automatic; it depends on a reciprocal process of interaction between mother and infant. Longitudinal studies show that problems in the interaction evident in the first few months and due to inept parenting and/or a difficult infant, may lead to resistant or avoidant attachment (Ainsworth 1979). Further, such patterns of attachment show stability into early childhood and later (for example, Arend, Gove, and Sroufe 1979; Waters 1978). Ironically, social support available to the mother (especially one in difficult circumstances) may be an important factor influencing the development of the sensitive and responsive interactions that promote attachment (for example, Crockenberg 1981). Further, the absence of opportunities for attachment has been shown to have serious consequences for development. Monkeys reared in isolation show difficulties later in interacting, mating, and parenting (Harlow 1965). Similarly, studies of children institutionalized during infancy suggest that the absence of a stable relationship with a responsive primary caregiver may result in later difficulties in forming attachments, if not more dramatic failures to thrive and develop (Provence and Lipton 1962; Spitz 1946; Yarrow 1961). The importance of early social relationships is evident in much psychoanalytic thinking also. Indeed Freudian theory often is attenuated to the view that psychological problems have their origins in the social relationships of early childhood. Later analysts such as Karen Horney (1945) would argue that anxiety is fundamentally a feeling of isolation and helplessness, to be resolved through one's social orientation, by seeking affection, independence, or power. Harry Stack Sullivan (1953) saw security as a basic human goal, pursued through relationships with others. In his view, social relationships (particularly the mother-child relationship) provided the basis for the self-system, composed largely of how the individual is seen by these others. More recent psychoanalytic thinking concerning "object relations" suggests that, although social relationships may develop for a variety of reasons, they generally must carry baggage from childhood relationships such as concerns with security and the satisfaction of other needs. In sum, as Kahn and Antonucci (1980) have noted, "Psychoanalytic, ethological, and sociallearning theories, each for different reasons and utilizing different mechanisms, emphasize the importance of the dyadic relationship between infant and primary caregiver" (p. 258). These theories too provide a precedent for the study of social relationships and well-being: they highlight the importance of early attachment and the needs served by later social relationships that in some views harken back to childhood issues. In contrast to psychodynamic thinking, social exchange theory views social relationships in terms of their more immediate and surface benefits (Homans 1961; Thibaut and Kelley 1959). From this perspective, individuals engage in social behavior that is rewarding, and relationships develop and persist over time to the extent that each individual involved can provide resources of value to the other (Burgess and Huston 1979). These resources might take any form, though Foa (1971) has suggested that the major kinds of rewards exchanged are love, status, information, money, goods, and services. According to these writers, relationships may begin with the exchange of tangible and universal resources (for example, goods and services), but close relationships are marked by symbolic and particularistic exchanges (for example, signs of affection) in which the identity of exchange 5

participants is crucially important. Further, although early theory viewed resources as equivalent, subject only to the valuation of participants, Foa and Foa (1980) have proposed that some types of resources are redeemable only in kind -- that one cannot buy love, for example. The cohesion of relationships depends on the reciprocal exchange of both benefits and costs, as well as on each individual's history and perception of current alternatives. Thus, an equitable exchange of rewards has been found to be related to satisfaction with dating relationships (Hatfield, Utne, and Traupmann 1979). Similarly, equity in the form of meeting expectations for mutual role performance has been shown to play a key role in satisfaction with marital relationships as well as in their stability and dissolution (Nye 1982; Spanier and Lewis 1980). Relationships are seen as developing with exchanges becoming more frequent, diverse, and greater in magnitude and risk. Thus, self-disclosures of ever greater intimacy are exchanged as a relationship progresses (Altman and Taylor 1972). Tolerance for shortterm deviations in reciprocity is far greater in close and longterm relationships than in less intimate and established ones (Levinger 1979), reflecting a history of trust, the cost of developing new relationships, and the high cumulative balance of exchanges in the relationship. From the social exchange perspective, individuals may have more or less of value to offer: some individuals may be advantaged, with many resources and favorable exchange conditions, whereas others may have little to offer and have little choice but to engage in unfavorable exchanges within relatively unsatisfying relationships. Thus social exchange theory provides another thread of interest in social relationships and well-being. Most notably, it reminds us that the benefits derived from social relationships are diverse and may be of idiosyncratic and situational value, that relationships require reciprocity over time, and that they develop and persist in an ecological context. Although not based explicitly on exchange theory, a comparatively recent discussion of social relationships shares the view that they may provide a variety of benefits. In his discussion of the provisions of social relationships, Weiss (1974) presented ideas that were to influence a number of social support researchers (for example, Henderson et al. 1978; Turner, Frankel, and Levin 1983) and provide the basis for several measures (Russell et al. 1984). Weiss (1974) proposed a model based on the assumption that some requirements for psychological wellbeing can only be met through social relationships. He argues that individuals maintain relationships in order to gain their provisions and that, in general, particular provisions require specialized relationships with distinct underlying assumptions. Six provisions of social relationships were identified, at least five of which bear some conceptual similarity to later descriptions of social support. Weiss (1974) presents a description of each provision, the kinds of relationship from which it is derived, and the affective consequences of its absence. These are briefly described here. Attachment involves a sense of security and comfort; it results primarily from marital and romantic relationships although some will obtain it through less intimate relationships. In the absence of attachment, individuals feel lonely and restless. Social integration is provided by a network of people that share concerns. It involves shared interpretation of experience, companionship, and opportunities for sharing services, and in its absence life may become dull. Reassurance of worth involves assurance of one's competence in a social role. It is provided by colleagues in the case of work roles and by family members and peers in the case of family roles. Reliable alliance is provided primarily by kin (especially siblings), who may be called upon for continued assistance even in the absence of mutual affection. In the absence of reliable alliance, the individual may feel vulnerable and abandoned. Guidance becomes most relevant in stressful situations. It involves emotional support, problem-solving guidance, and is derived from relationships with persons who are trusted and respected. In sum, Weiss (1974) has provided a provocative description of several social provisions, the kinds of relationships that generally provide these, and in some cases the affective consequences of their absence. 6

THE FOUNDATIONS OF CURRENT INTEREST IN SOCIAL SUPPORT Three scholars laid much of the groundwork for discussion and research of social support over the past decade (Caplan 1974; Cassel 1974a, 1974b, 1976; Cobb 1976). John Cassel (1974a, 1974b, 1976), an epidemiologist and physician, argued that psychosocial processes are of considerable importance in disease etiology and that social support, in particular, plays a key role in stressrelated disorders. Cassel (1974b) was interested in understanding ecological findings linking noxious urban conditions, such as poor housing, crowding, and the disruption of neighborhoods, with higher rates of physical and psychological disorder, including infant mortality, tuberculosis, and psychosis. Drawing on animal research showing that various forms of social disorganization could reduce resistance to disease, he argued that the disruption of significant social ties produced by stressful environmental conditions might leave the individual with inadequate or confusing feedback, resulting in disequilibrium and heightened susceptibility to disease. Social feedback was also a key element in Cassel's notion of social support. Although he never defined it precisely, he viewed support as being provided by primary groups, those most important to an individual, and as serving an important protective function, "buffering" or "cushioning" the individual from the somatic or psychological consequences of stressful experiences. Thus social support was prominent among the health-protective category of psychosocial processes. As such it helped explain variations in disorders among people sharing apparently similar environmental conditions: because the feedback provided by their respective primary groups would vary, the health and well-being of some would be protected more than others. Indeed, Cassel (1974b) advocated the mobilization of social support as a more feasible direction for intervention than attempting to reduce exposure to environmental stressors -- a viewpoint that has persisted and that underlies much of the interest in social support. Cassel recognized also that stress and support sometimes intertwine in that stressful events often disrupt social ties, as in the case of divorce, job loss, or bereavement, thus diminishing support while adding demands. This link between stressors and support has been largely ignored -- as a conceptual or methodological inconvenience -in most research on the buffer hypothesis. In conclusion, as Gottlieb (1981) has summed up, "Cassel's main legacy rests on the two lines of ecological inquiry he spurred: inquiries devoted to analyzing how people's interactions with the social environment conspire to augment their vulnerability to illness and disease, and how social forces can be mobilized in these situations for the sake of health protection" (p. 23). Gerald Caplan (1974) incorporated Cassel's formulations -particularly regarding social feedback -into his ongoing work in preventive psychiatry and community mental health that he had begun more than a decade earlier (Caplan 1964). These ideas meshed well with his own views on the role that others might play in influencing the course and outcome of crises and developmental transitions experienced by an individual. Although Caplan used the term "support system," he did not expand on the structure of such systems, nor did he suggest how they develop or are maintained. He did note the importance of reciprocity and durability of relationships. Yet it is clear from his discussion that the support system is not limited to family and friends, but includes mutual-aid groups, neighborhood-based informal services, and the aid provided by community caregivers such as clergy. These "continuing social aggregates" provide opportunities for feedback about one's identity and performance. Caplan did elaborate on the kind of help the support system might provide, suggesting three main sets of activities: helping one mobilize psychological resources to manage emotional problems; sharing demanding tasks; and providing materials, money, skills, and guidance to help in dealing with specific stressors. With support "strategically placed" in each of the settings where an individual spends time, he or she might be protected almost completely from the adverse effects of 7

stress. Thus Caplan emphasized the importance of support systems in protecting individual wellbeing in the face of everyday demands, situational crises, and life transitions. He also suggested the kinds of assistance provided by these systems, setting the stage for discussions of the proper scope and important types of support activities. In light of his contributions to community mental health, it is not surprising that Caplan (1974) also had a good deal to say about the role that formal caregivers might play in mobilizing, enhancing, creating, and collaborating with informal support systems. His discussions in this regard suggested a number of paths for support-based interventions and outlined several important issues regarding the informal and formal delivery of services. In his address to the American Psychosomatic Society, Sidney Cobb (1976) took a view, similar to that of both Cassel and Caplan, regarding the importance of social support in relation to stress and well-being. He was more precise, however, in his efforts to provide a conceptual definition for social support. He proposed that social support be viewed as information: specifically, information leading the person to believe that he or she is cared for and loved, is valued and esteemed, and belongs to a network of communication and mutual obligation. Cobb (1976) addresses two important and related functions of this information: fulfillment of social needs and protection from adverse consequences of crises and stressors. Thus, the three kinds of information reflect emotional support, derived from intimate and close relationships and fulfilling affiliation and succorance needs; esteem support, generally proclaimed in public and meeting needs for recognition and bolstering sense of selfworth; and belonging support, providing a sense of orientation in society and membership in a definite social group (compare Murray 1938; Leighton 1959). Cobb's major emphasis, however, is social support as a stress-buffer. He discusses a wide range of studies in which the absence, existence, or quality of social relationships seems implicated in wellbeing, throughout the life span. Cobb (1976) conclusion is that adequate social support can protect people in crisis from a variety of physical and psychological disorders, presumably through the facilitation of coping and adaptation. Cassel, Caplan, and Cobb laid the foundation for work on social support. They outlined the scope of the topic, suggesting the kinds of social relationships and activities that were involved. They established the research issue that has dominated the field ever since -- that social support acts to buffer the adverse effects of stress, be they psychological or somatic. Finally, they sowed the seeds for interest in social support as a focus for social intervention. Numerous other researchers and commentators contributed to the shape of social support theory and research from the mid-1970s to the present (Dean and Lin 1977; Gottlieb 1981; Henderson 1977; Heller 1979; Hirsch 1979, 1980; Kaplan, Cassel, and Gore 1977; Mitchell and Trickett 1980; Tolsdorf 1976). Studies addressed the size and structure of social networks, the availability of confidantes, and satisfaction with different types of support. The networks of psychiatric, medical, and normal samples were compared. The relationship between psychological distress and social support (variously conceived and measured) was examined among samples experiencing some particular life transition or varying levels of stressful life events. Over more than a decade, the major questions asked in social support research have changed little, although they came to be asked with greater precision and sophistication. Yet first, research on the topic blossomed in a profusion of varieties.

THE SCOPE OF SOCIAL SUPPORT RESEARCH Regarding the various perspectives on social support, Turner, Frankel, and Levin (1983) comment that "most focus upon the helping elements and processes of the social-relational systems in which the individual is located" (P. 72). Indeed they do, but there the similarity ends. The particular elements, processes, and social-relational systems examined are quite diverse. Cassel, Caplan, Cobb, and other early contributors may have provided a rough sketch of the area, but in filling in the details, researchers have made manifest remarkably different visions. The picture presented by the social support literature is both complex and confusing. Discord and diversity have coalesced around three issues: the range of social ties that are relevant to support, the relative importance of objective features of social relationships and supportive behavior versus the individual's perception or appraisal of these, and the variety of forms that support might take. The Range of Social Relationships Investigators have focused on the full range of social ties relevant to social support, from integration with the community or neighborhood through ties to a broad social network to bonds with intimate confidantes (Gottlieb 1981a; Heller 1979). The relative importance of these levels of social ties is still a matter of some dispute (Gottlieb 1981b; Turner, Frankel, and Levin 1983; Wellman 1981). Social Integration A number of researchers have examined the individual's degree of social integration in terms of such factors as marital status, contact with friends and relatives, and membership in voluntary associations (Bell, Leroy, and Stephenson 1982; Berkman and Syme 1979; Eaton 1978; Gore 1978; Lin et al. 1979; Miller and Ingham 1976; Myers, Lindenthal, and Pepper 1975; Warheit 1979; Williams, Ware, and Donald 1981). For example, Eaton (1978) performed a reanalysis of the New Haven data (Myers, Lindenthal, and Pepper 1975), in which social support was operationalized by eight indices: being married, belonging to clubs, belonging to church, visits from friends, visits from relatives, going out with others often, having a very close friend, and living alone. Lin et al. (1979) studied social support among Asian-American adults using a composite measure that included having close friends in the area, feelings about the neighborhood, and involvement in ethnic associations and activities. Williams, Ware, and Donald (1981) used a measure that included religious participation, telephone contacts, group participation, and social contacts. Because they concern the ultimate outcome, death, the findings of a study by Berkman and Syme (1979) serve to illustrate the strength and limits of this approach. These researchers examined ageadjusted mortality rates for a stratified random sample of Alameda County, California. For both males and females, in every age group, mortality rates were significantly higher for those low in social integration, based on a measure that combined marital status, contact with friends and relatives, participation in formal and informal organizations, and church membership. Findings such as those of the Berkman and Syme study are dramatic. Yet their importance adds piquancy to the questions they raise about the nature of such social involvement: specifically, if indeed such ties can reduce the probability of psychological distress or illness -- let alone death -what is the crucial protecting ingredient? Gottlieb (1981) makes this point when he asserts that studies using such molar measures "document the proposition that 'social factors' are capable of altering health states . . . but tell us nothing about the number and kind of social contacts associated with low-risk status, or about the interpersonal processes that may lie at the heart of social support" (p. 205).

Because integration measures so often confound different elements, little is known about the relative importance of socializing, ties to kin, religious involvement, or other affiliations. It is unclear whether benefits accrue from the meeting of spiritual needs, the fun of being with friends, the sense of identity derived from affiliations, or some other process. In short, findings concerning general social integration, although often provocative, leave many important questions unanswered. Many of the measures noted above were derived from large-scale epidemiological data sets that drew on a tradition of social integration research that predates contemporary interest in social support. Such studies often involve elaborate sampling, large sample sizes, and longitudinal designs that require a considerable investment of time and energy. The considerable lag between study design and completion makes them less responsive to developments in measurement than, for example, small sample cross-sectional studies of college students -an arena in which a number of elaborate support measures have developed. To some extent, then, the integration approach reflects an adaptation of earlier interests. Nevertheless, because of strengths other than their measures, largescale epidemiological studies often feature very prominently in reviews of the social support literature (for example, Kessler and McLeod 1985; Lin 1986a; Mitchell, Billings, and Moos 1982). They constitute a foundation for current knowledge, whatever the limitations of the integration measures often used. Nor should it be concluded that social support researchers are no longer interested in social integration. As Lin, Dumin, and Woelfel (1986) have pointed out recently, "The community represents the outermost layer of social relations within the social environment exerting an impact on an individual" (p. 155). Among a diverse set of measures used in their research are three that tap community support. These multi-item scales focus on neighborhood interaction and satisfaction, participation in voluntary organizations, and use of organized services. However, the social integration approach is less prominent in the social support literature than it was ten years ago and generally has given way to more detailed assessments of the nature and quality of social network ties. Intimate Relationships At the other extreme, some researchers have focused on the availability of intimate relationships (Brown, Brolchain, and Harris 1975; Lowenthal and Haven 1968; Medalie and Goldbourt 1976; Miller and Ingham 1976). That intimate relationships are important to wellbeing can hardly be disputed. Most readers will have experienced the joy of falling in love or making a new friend and, perhaps, the pain of lost love, moving away from friends, or seeing a close friendship deteriorate. Some time ago, Parks, Benjamin, and Fitzgerald (1969) observed dramatic increases in the death rate of persons recently widowed. Fried (1963) studied the distress resulting from residential relocation and the associated disruption in friendships. More recently, Bloom, Asher, and White (1978) reviewed evidence of the adverse consequences of divorce and separation. In short, it is well documented that the loss or disruption of close and intimate relationships may have a negative effect on well-being. Other research shows that intimate relationships may promote well-being and protect individuals from the effects of stressors. Thus, Lowenthal and Haven (1968) observed that among older adults the availability of even one confidante can serve as a buffer against gradual losses in social roles and even some of the more traumatic losses accompanying widowhood and retirement. Individuals with one or more confidantes report greater life satisfaction, more positive affect, and fewer health problems than those without such social ties (Lowenthal and Haven 1968; Miller and Ingham 1976). Researchers such as Medalie and Goldbourt (1976) have taken a somewhat different tack by focusing on the quality of marital relationships. In their fiveyear incidence study of angina pectoris among a large panel of men, quality of marital relationship emerged as an important factor

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influencing risk. Quality of the marital relationship figures prominently in theory and research on a number of psychological problems including depression and anxiety problems. The argument that intimate relationships are central to social support processes is quite compelling. Less convincing is the view that these relationships capture everything of importance. Certainly, persons with poor marriages may or may not find intimacy or friendship elsewhere. Having a confidante may be important, but surely few individuals draw exclusively on one friend in times of need, and most certainly it is a remarkable confidante who can help with all problems. It seems far more plausible that different people possess different talents and resources and would be helpful under different circumstances. Having someone to whom one can bare one's soul may be important, but so might having someone who knows how to fix cars or where one can find a job. In short, an exclusive focus on intimate ties or single confidantes seems too restrictive to capture all that is deemed important in social support. Social Networks The intermediate level of social environmental ties, social networks, represents a flexible compromise between the integration and intimacy approaches. This approach allows a broad range of social ties to be examined. Yet by carefully choosing the questions used to elicit network member nominations, researchers can highlight intimate relationships, family relationships, or ties to people in settings such as the workplace, neighborhood, or informal associations. Further, social networks have systemic properties hinted at in early discussions of social support systems (for example, Caplan 1974). Indeed, the terms social network and social support system often are used interchangeably, although not without problems. The social network approach was adapted from earlier use in anthropology (for example, Barnes 1954; Mitchell 1969), where it was used to examine social structure and interactions. Social network concepts were incorporated in several early studies of social support (Hirsch 1979; Barrera 1981; Tolsdorf 1976) and advocated by several commentators (Mitchell and Trickett 1980; Wellman 1981). Social network analysis within this literature has been limited almost exclusively, to date, to the examination of a focal individual's network -- the system of relationships with other individuals -- originally termed a "personal network" (for example, Mitchell 1969). Neither the collection of networks within a population or group nor the links between social units (for example, families, work groups, and agencies) have been examined, although Wellman (1981) has pointed out the importance of viewing personal networks in the context of larger social systems. The social network may be examined with respect to its structure, composition, and component relationships. Important structural features include size (the number of individuals included in the network) and density (the interconnectedness of individuals in the network). Noteworthy aspects of network composition might include, for example, the proportion of family members, friends, neighbors, or workmates. Network composition might also be assessed in terms of the homogeneity between network members and the focal person, with respect to age, sex, social status, or ethnicity. Many features of network relationships might be examined, including the frequency of contact, geographic proximity, and the durability and intensity of relationships. The content of exchanges in the relationship, the degree of reciprocity involved, and whether the relationship involves one or multiple types of exchange, multiplexity, may also be examined. In short, social network analysis provides a rich store of concepts with which social support might be examined, a store that has yet to be fully exploited. To illustrate, Tolsdorf (1976) compared the social networks of medical patients and first-admission schizophrenics using data from an extensive interview. He examined network size, twelve broad exchange content areas (for example, economic and recreational), and three functions (support, 11

advice, and feedback), as well as reciprocity, multiplexity, and other network features. Tolsdorf found that, compared to the medical patients, the schizophrenics reported networks composed of a higher proportion of kin, fewer multiplex relationships, and fewer reciprocal relationships. Although aware of the likelihood that disorder and network each influenced the other, Tolsdorf argued that the impoverished network available to the schizophrenics afforded them limited assistance in coping with their difficulties. Later studies further examined structural properties of the network, notably size and density (Hirsch 1979, 1980; Stokes 1983), as well as the quality of network relationships (Vaux and Harrison 1985), in relation to supportive behavior and support appraisals. A point of contention concerns the degree to which social networks and support networks are distinguished conceptually. In early research, the distinction was not highlighted, and network members were identified by asking the respondent to name people important to him, to list family, friends, workmates, and others with whom he interacts with some given frequency, or to identify people with whom he has an ongoing personal relationship. Mitchell and Trickett (1980, p. 29) list operational definitions of social networks from some seventeen early reports and note that they differ markedly with respect to inclusiveness. Further, some researchers specified a necessary frequency of interaction whereas others did not. Some aimed at an exhaustive network list; others sought a representative subset. Finally, some allowed respondents considerable scope in identifying "significant" relationships; others did not. This last point is the most problematic -when instructions to the respondent are vague, the nature of the identified network is ambiguous. More important, many early studies shared a common problem, the failure to distinguish the support network from the larger social network and to identify specifically that network of individuals who provide support. Underlying this failure was the unspoken, and unlikely, assumption that all social ties are supportive. This difficulty, of course, reflected the more general ambiguity regarding the exact nature of social support. In reaction to the indefinite approach to network assessment just outlined, some researchers argued the necessity of specification and focus: whatever particular subset of the social network was of interest should be identified and measures developed accordingly (Barrera 1981; Jones and Fischer 1978; Wilcox 1981). For example, Jones and Fischer developed a set of items designed to assess the availability of assistance in particular circumstances. More comprehensive support network measures were developed that identified persons providing particular types of support, such as emotional, financial, practical, and guidance (Barrera 1981; Vaux 1982). Such measures avoid the assumption that all social ties are supportive and focus only on those that generally are. This more focused approach allows distinctions between subnetworks providing different modes of support and an examination of the degree to which these overlap, as well as a detailed examination of the quality of network relationships (Vaux 1982) including their propensity for conflict (Barrera 1981). From this perspective, support networks are a subset of larger social networks. Not all researchers, however, favor the focused approach. Wellman (1981), for example, has argued eloquently that support should be examined within the context of broad social network ties. For example, he writes, "Furthermore, by looking at a broad range of ties, we more accurately treat support as a contingency rather than a fixed relationship. We cannot freeze ties in aspic as supportive or non-supportive, whatever cross-sectional slices we take of an individual's life" (p. 180) and "New alliances emerge to cope with new contingencies" (p. 180). These are important points. Certainly, it is essential to understand the circumstances under which relationships provide support or fail to do so -- the existence of a supportive relationship should not be equated with support (nor is it by most researchers taking the focused approach). Focused support network measures should be designed carefully to avoid excluding potential supporters, although new and unpredictable alliances may form and go unobserved, as Wellman argues. Yet, countering these

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difficulties has less to do with the kind of networks assessed than the kinds of data that are collected about them over time, including the interactions that occur within network relationships. Indeed, Wellman (1981) arguments can be seen less as a condemnation of a focused approach to support networks and more as a reminder of some important research questions. How stable over time are supportive relationships? Do new alliances emerge to cope with new contingencies or are old alliances generally called upon? How are supportive relationships embedded within the larger social network? This latter, general question encompasses a multitude of others and requires a research strategy that complements an exclusive focus on support networks. None of these questions, however, can be answered without precision in delineating support. Social network analysis provides a wealth of conceptual tools for examining social support. To date, the full scope of this approach has not been exploited, although studies have addressed many features of networks including size, composition, density, boundary density between family members and friends, overlap between the networks of separated couples, and the reciprocity, multiplexity, closeness, and conflict of network relationships (Barrera 1981; Hirsch 1981; Tolsdorf 1976; Vaux and Harrison 1985). These features have been related to supportive behavior, support appraisals, and psychological distress. Confusion and controversy persist regarding whether, and how, support networks should be distinguished from larger social networks. Yet increased specification of support networks has occurred and corresponding measures developed. Network analysis continues to provide a focus for research on social support and likely will play an important role in facilitating a more complete understanding of support phenomena. Conclusion Lin (1986a) recently suggested that a person's linkage to the social environment can be represented at three distinct levels: the community, the social network, and intimate and confiding relationships. Although it has occurred more haphazardly than systematically, social support research has indeed addressed a wide range of links between person and social environment, with these three levels emerging as focal themes around which research strategies have been built. Legitimate research issues regarding social support arise at all three levels and will require complementary research at each level. Yet early work, much of which highlighted either general social integration or intimate relationships, has been criticized as being too general or too restricted, respectively. Conceptual and methodological tools adapted from network analysis appear to be a promising intermediate strategy, particularly when the types of support involved are carefully specified. Actual and Perceived Features of Support A second source of variety in social support thought and research is a familiar one, common to many areas of behavioral and social science. It concerns the degree to which we focus on events and activities or on individual perceptions of these. This issue cuts across the levels of social linkage discussed above. For example, should social support researchers count the number of friends that a person has or how often they are visited? Is a person's membership in informal organizations the proper object of study? Should intimate relationships be observed to assess the frequency of carefully defined activities, such as expressing empathy, making suggestions, or sharing tasks? Or should the spotlight be turned on the individual's perception of these events and activities -- his sense of belonging to a church congregation, her feelings of being bonded with friends, his conception of the support provided or available within a close relationship? The issue has both philosophical and pragmatic dimensions. Even a researcher taking a staunch positivist position would be hard pressed to delineate, let alone measure, the extensive and disparate social ties and interactions that are encompassed within the topic. Further complications would arise 13

from the fact that crucial interactions, being intimate, tend to occur in private. This is not to say that a sufficiently persistent researcher might not carve out a limited research area and overcome some of these problems, but to date the individual respondent has been the major source of data about his or her affiliations, social involvement, network, friends, and confidantes, as well as about the interactions that occur within these relationships. In short, the subject's view of social ties and interactions has been prominent for pragmatic reasons, blurring the conceptual distinction between objective and subjective aspects of social support. Early studies, in particular, paid little attention to distinguishing actual from perceived elements of support, and the measures employed often contained items reflecting both. In general, the social integration approach tended toward an assessment of actual memberships and ties, using indices made up of the number of organizational affiliations, number of friends and relatives nearby, or the frequency of visits (Eaton 1978; Miller and Ingham 1976; Williams, Ware, and Donald 1981). Yet, even early social integration measures sometimes included clearly subjective appraisals of involvement or satisfaction (for example, Lin et al. 1979). Studies focusing on intimate and confiding relationships essentially counted the existence or not of these relationships, although specification of the relationship allowed a significant subjective component. Similarly, the social network approach gives the appearance of an objective focus (counting the number of network members, mapping network density), yet the questions used to elicit nominations tended to be vague, allowing considerable idiosyncracy in interpreting "significant relationship" or "friend," for example. This was true particularly of early work. More recently, measures have used questions that specify classes of activity in eliciting network nominations, although subjective aspects of network relationships such as closeness, reciprocity, and conflict may be separately assessed (Barrera 1981; Vaux 1982). Several writers have argued the importance of the individual's experience of supportive relationships and interactions (Heller and Swindle 1983; Procidano and Heller 1979, 1983; Turner, Frankel, and Levin 1983; Vaux et al. 1986). This view follows a long tradition emphasizing the person's construction of the world. Some 2,000 years ago, the Roman philosopher Epictetus stated, "Men are disturbed not by things, but by the views which they take of things." Turner, Frankel, and Levin put their position in a disciplinary context, "It is, after all, an axiom of social psychology that events or circumstances in the real world affect the individual only to the extent and in the form in which they are perceived" (p. 74). They go on to write that social support may best be viewed as a personal experience rather than as a "set of objective circumstances or even a set of interactional processes" (p. 74). Much of the time, perception and actuality will correspond, often closely. But in those instances when they diverge, when, for example, an act is seen as a kindness although it was not intended as such, surely the perception of support will be influential. In dealing with environmental demands, the perception that others are willing to help, even when illusory, surely will afford a degree of comfort, just as the belief that one has the necessary coping skills will diminish a threat, even when one's capability is actually in doubt. This is not to deny that on occasion actual assistance will be required, the lack of which will have adverse effects, to say nothing of the distress that may result from becoming cognizant of one's illusions. Actuality and perception may diverge in the opposite manner also. Supportive acts may go unrecognized; affection may be taken for granted. In some cases, even unrecognized support may be influential, as when a shared task is completed more quickly, but, in most cases, the perception of support or its absence would seem likely to have an effect regardless of actuality. At the extreme, one might argue that a large component of social support goes on in close relationships. What constitutes support in these relationships may be embedded in the private language that 14

characterizes communication in close relationships -- special gestures, private jokes, obscure allusions, private meanings, and shared associations. The prospect of examining such processes without relying on the subjective appraisals of participants seems daunting in the extreme. Social support phenomena involve both objective and inherently subjective elements: both actual events and activities and the participants' perception and appraisal of these. Both must be addressed for a complete understanding of social support. The broad extent of individuals' social relationships and the privacy surrounding many relevant interactions have forced most data to be collected through the filter of the focal person. Nonetheless, methodological and pragmatic issues aside, this should not obscure the distinction between actual events and activities and the subjective appraisals of the individual. Forms of Social Support A final source of diversity and confusion in social support thought and research concerns the varied forms and functions of social support. People assist one another in an astonishing variety of ways, and relationships serve many functions. Unfortunately this richness has been mirrored in the literature by a proliferation of terminology and a host of overlapping typologies, few of which have achieved widespread currency. Further, recommendations that different modes of support be distinguished far outnumber efforts to develop corresponding measures. In the vast majority of support research to date, some modes are highlighted at the expense of others, or several modes are confounded within a single measure, but studies that include reliable and valid measures of more than one mode are the exception, and those that test mode-specific hypotheses are a rarity. In delineating the topic, early writers sketched out the kinds of activities that constituted support. For example, Caplan (1974) noted three broad categories of activity: helping to mobilize resources and manage emotional problems, sharing tasks, and providing material and cognitive assistance to help deal with a particular stressful situation. Others have distinguished functions that might be served by support. For example, Cobb (1976) distinguished information leading to beliefs of being cared for, esteemed, and involved. Weiss (1974) distinguished six provisions of social relationships, including attachment, social integration, reassurance of worth, reliable alliance, guidance, and opportunity for nurturance. Cobb and, to a greater degree, Weiss see particular functions as linked to certain types of relationships. Of particular importance was Weiss's view of social provisions as relational, that is, arising from the relationship, not from particular activities. Numerous other researchers have distinguished modes and functions of social support. The terminology and distinctions made are varied and confusing: instrumental and affective (Pattison 1977); tangible, intangible, advice, and feedback (Tolsdorf 1976); concern, assistance, valued similarity, positive interaction, and trust (Brim 1974); emotional support, cognitive guidance, tangible assistance, social reinforcement, and socializing (Hirsch 1980); self-esteem, appraisal, belonging, and tangible support (Cohen and Hoberman 1983); emotional support, socializing, practical assistance, financial assistance, advice/guidance (Vaux 1982); emotional, appraisal, informational, and instrumental (House 1980); esteem, informational, instrumental, social companionship, motivational (Wills 1985); and instrumental and expressive (Lin, Dean, and Ensel 1986). To complicate matters further, forms of support sometimes are merely listed; at other times they are carefully defined. When defined, a term used by different writers may have different connotations. Nevertheless, with patience a pattern can be discerned. Three strategies are helpful: distinguishing activities and functions, examining empirically generated forms of assistance, and following up on earlier reviews.

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Activities and Functions In mapping out types of social support, some writers have highlighted supportive activities; others, the functions of support; and many have not made this distinction. Nor is it a straightforward distinction, because activity and function are related. Supportive activities are what people do and include an astonishing array of, often very subtle, social behavior such as listening, expressing concern, showing affection, sharing a task, caretaking, loaning money, giving advice, making suggestions, and socializing. The functions of social support concern less the specific activities and more the consequences of (or purpose served by) those activities and the ongoing relationships in which they occur. Examples include love, belonging, intimacy, and integration. Evidence of a support function can be obtained only by an examination of subjective appraisals -- the person's cognitive-affective condition -- of his or her sense of being loved, of belonging, or of feeling attached, for example. Shumaker and Brownell (1984) make a similar distinction "between what support is supposed to do for the recipient, its functions, and how these functions can be achieved, the resources provided in supportive exchanges" (p. 22, original italics). For example, the distinctions proposed by Brim (1974), Cobb (1976), Lin (1986a), and Weiss (1974) reflect functions whereas those of Barrera (1981), Gottlieb (1978), Hirsch (1980), House (1980), and Vaux (1982) reflect activities. Clearly, activities and functions are linked, sometimes closely. For example, emotionally supportive activities such as listening, expressing concern, being affectionate, or comforting (Barrera 1981; Gottlieb, 1978; Vaux 1982) are within the same domain as support functions such as love, trust, intimacy, and attachment (Brim 1974; Cobb 1976; Foa 1971; Kaplan, Cassell, and Gore 1977; Weiss 1973). Some functions are quite global and seem to involve several modes of supportive activity. For example, providing assistance and socializing might also serve functions such as love or attachment -- the links between activities and functions are complex. Also, some domains of support seem more easily described in functional than activity terms, as reflected in the elusive term "intangible" support whereas other domains are more easily described by activity than functional terms, for example, practical assistance, advice/ guidance, or material aid. In short, it seems awkward to use activity or functional terms consistently across the various forms of support. Nevertheless, remaining cognizant of the difference between supportive activity and support functions is helpful in two ways: it serves as a reminder that the link between activities and cognitive-affective states is not a simple one, and, more important for the present task, it helps clarify patterns in typologies of support. Empirically Generated Forms of Helping Gottlieb (1978) conducted one of the few studies to examine empirically generated helping behaviors. He asked a sample of single mothers to provide explicit descriptions of how they were helped in relation to several current difficulties -- eliciting details of both activities and qualities of the helper. A content analysis of interview responses by three judges generated twenty-six categories of helping, into which responses were reliably coded. These categories were organized into four classes; emotionally sustaining behavior, problemsolving behaviors, indirect personal influence, and environmental action. Subclasses were also evident. For example, emotionally sustaining behavior included twelve categories that could be grouped into classic counseling techniques (for example, listening, reflecting understanding, trust, concern, and respect), being there through stressful periods, and providing reassurance and encouragement. Subclasses could also be discerned among the problem-solving behaviors, including providing advice and guidance (for example, providing clarification and making suggestions), providing direct practical assistance (for example, supplying transportation), and engaging in socializing to distract from the problem.

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Informal helpers provided different kinds of assistance to respondents experiencing different problems, such as child centered, emotional, and financial. For example, respondents reported receiving mostly emotionally sustaining support for emotional problems, emotional and problemsolving support for child-related problems, and problem-solving support for financial problems. Further, almost 75 percent of emotional assistance took the form of unfocused talking, listening, and reflecting understanding. Similarly, most problem solving consisted of focused talking, providing suggestions, modeling or relating ways of coping, and supplying direct practical assistance. In sum, the single mothers in Gottlieb's study received a broad range of assistance in dealing with difficulties. Forms of assistance were problem sensitive and, particularly at the subclass level, reflected modes of support distinguished in a number of typologies (for example, Barrera 1981; Caplan 1974; Vaux 1982). Any useful typology of supportive activity would need to include the classes observed by Gottlieb. Reviews of Support Typologies Several writers have published reviews of support typologies, attempting to bring some order to the disparate distinctions (Barrera and Ainlay 1983; House 1980; Mitchell and Trickett 1980). These reviewers suggest that a consensus might be possible around some four to six types of support. For example, in an early discussion of social networks, Mitchell and Trickett reviewed five classification schemes from earlier theoretical and empirical work. They suggest that social networks and support systems serve four general functions: emotional support; task-oriented assistance, communication of expectations; evaluations, and a shared world view; and access to diverse information and social contacts. Yet, if one examines the basis for this conclusion (their Table 3, p. 32), it is clear that the earlier classifications do not slot neatly into Mitchell and Trickett's scheme. Nonetheless, this review was an important start in delineating the forms that social support can take. Barrera and Ainlay (1983) provide a more detailed review of the structure of social support. In response to criticism that the term was becoming overinclusive, these authors sought to delineate the concept without excluding important functions. They reviewed ten key articles that provided some conceptual discussion of social support or related concepts and that included distinctions among forms of support. In searching for points of convergence on which a rational typology might be built, they used several noteworthy guidelines: a broad view of support was adopted; support was not restricted to a stress-buffering role; and, of considerable importance, emphasis was placed on activities not "affective or cognitive responses to social exchanges." This last guideline represents somewhat of a departure from earlier work. Barrera and Ainlay draw conclusions comparable to those of Mitchell and Trickett although they further subdivide some categories. Six categories are proposed: material aid (providing materials and money), behavioral assistance (sharing tasks), intimate interaction (traditional nondirective counseling activities), guidance (offering advice, information, or instruction), feedback (providing feedback about behavior, thoughts, or feelings), and positive social interaction (social interactions for fun or relaxation). This typology has a number of advantages: it captures many of the distinctions explicit or implicit in discussions of social support and the descriptions of each category clearly identify the kinds of activities that constitute that mode of support. Indeed, the typology provided the basis for Barrera (1981) Inventory of Socially Supportive Behaviors. Further corroboration of its utility is provided by the fact that an independently developed measure of supportive behavior (SSB: Vaux 1982) was based on a very similar typology although it resulted from a less formal review of the literature.

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The strength of Barrera and Ainlay's typology -- its emphasis on supportive acts -- is also a limitation. From some perspectives, the cognitive-affective consequences of supportive activities and relationships are at least as important as supportive acts, if not of primary importance. In the next section, typologies of both supportive activities and the functions of support are presented and related to one another. Conclusion Social support takes many forms; supportive relationships serve several functions and supportive behavior involves several kinds of activity. Most writers implicitly or explicitly recognize this multidimensional aspect of social support, yet achieving consensus on important distinctions has been difficult. Three strategies were used here in trying to extract a pattern: distinguishing functions and activities, examining empirically generated forms of helping, and examining reviews of support typologies. Table 1.1 represents an effort to represent these discussions. Correspondence may not be perfect, especially between functions and activities; nonetheless, this representation captures much of what has been said about the forms of social support. Instrumental functions may be served through the provision of goods or money (material aid or financial assistance) and through providing information, making suggestions, and clarifying issues (advice and guidance). This latter mode of supportive behavior, however, may also serve functions related to esteem and identity. Affective functions include meeting needs for love and affection, esteem and identity, and belonging and companionship. These needs are met respectively through emotional support, feedback and social reinforcement, and socializing. No doubt some will dispute this typology of the functions and modes of social support. Certainly, it will bear refinement. Yet it should serve as a guide, to help researchers more clearly identify their particular interests and to put focused studies in a more general context.

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COMPLEXITY OF THE IDEA Multifaceted Nature of Social Support The idea of social support has been described alternately as rich and subtle or as diffuse and vague. As outlined earlier, support seems to encompass a multitude of activities, relationships, and subjective appraisals. Activities deemed supportive might include comforting a distressed friend, encouraging someone facing a difficult task, listening while someone describes a problem he or she faces, accepting selfdisclosure in a spirit of trust, lending money or materials, giving advice, making suggestions, sharing a task, and providing information. Support viewed in terms of relationships might include having friends, visiting neighbors, having a confidante, being married, spending time with friends, being involved in informal social organizations, or having a relatively large network of people on whom one can call for assistance. Alternatively, support might be viewed in terms of subjective appraisals that focus on the quality of one's relationships (with a spouse, family, friends, workmates, or neighbors) or on the degree to which important social needs (for example, for affiliation and intimacy) are being met or on the degree to which one feels cared for and valued. In short, social support has been viewed from diverse perspectives involving multifarious relationships, activities, and evaluations. Problems of Imprecision The richness of an idea can be an obstacle to systematic scientific study. The multifaceted nature of social support precluded a simple conceptual definition. Consequently both the construct and its relationship to other constructs such as stress and disorder remained vague. As a result, measures proliferated without adequate focus, reliability, or validity (compare Dean and Lin 1977; Tardy 1985; Vaux et al. 1986), social support was inadequately differentiated from other constructs (compare Heller and Swindle 1983; Thoits 1982), and hypotheses regarding support effects were imprecisely modeled and improperly tested (compare Finney et al. 1984; Wheaton 1986). Further, the dissimilarity of focus and measurement made it very difficult to evaluate and integrate findings. The richness of the idea -- central to its appeal -- hampered systematic research on social support. Imprecision denied social support theory an essential property, the possibility of refutation. These problems are only now being overcome. Emergence of Distinct Approaches Over time, a number of distinct approaches to social support emerged. These included focusing on the structural aspects of social networks, confidantes, perceived support, comparing sources of support, and contrasting modes of support. However, the adoption of a particular approach often was unself-conscious. Researchers gave little indication that a choice had been made and/or failed to provide an explicit rationale for their choice. More important, different perspectives on social support typically were seen as different measurement strategies, not as the operationalization of different constructs -- an important distinction. It has taken much of the decade for a widespread understanding of the full scope of social support phenomena to develop and for a proper conceptual perspective to emerge on the various approaches to the topic. Resolving the Conceptual Issues A number of writers have remarked on the confusion and lack of consensus regarding a theoretical definition of social support (Carveth and Gottlieb 1979; Thoits 1982; Turner 1981; Vaux et al. 1986). The majority of studies have been conducted without explicit reference to a definition, appealing instead to one of the established traditions. Clearly, the confusion has not prevented studies from being conducted, but it has obstructed the synthesis of findings and the efficient 19

development of research. Less directly, it has hampered the evolution of theory and marred the design of interventions. Most delineations of the topic constitute working assumptions rather than theoretical definitions and, as Thoits (1982) notes, often beg the question by including the term to be defined or some undefined substitute. For example, support has been delineated as "the relative presence or absence of psychosocial support resources from significant others" (Kaplan et al. 1977, p. 50) and "support accessible to an individual through social ties to other individuals, groups, and the larger community" (Lin et al. 1979, p. 109). Other researchers have relied on lists of relationships, functions, or activities in efforts to delineate social support (Caplan 1974; Cobb 1976; House 1980). Such accounts of support, particularly when carefully considered (for example, House 1981), provide a foundation for theoretical definitions and can be very helpful in developing measures, yet they seem incomplete. The difficulty of trying to capture such a complex idea in a single statement should not be underestimated. A number of more recent efforts to grapple with the problem are outlined below. Thoits (1982) proposed a view of support based on that of Kaplan, Cassell, and Gore (1977). She defined it as "the degree to which a person's basic social needs are gratified through interaction with others" (p. 147). These needs were identified as including affection, esteem or approval, belonging, identity, and security (p. 147). Needs are met by the provision of socioemotional aid (for example, affection, understanding, and esteem) and instrumental aid (for example, advice, information, money, and assistance). Further, "The social support system will be defined as that subset of persons in the individual's social network upon whom he or she relies for socioemotional aid, instrumental aid, or both" (p. 148). Most notably, then, Thoits distinguishes the gratification of needs, the provision of aid, and the social support system. Also, both needs and aid are multidimensional. Turner, Frankel, and Levin (1983) have taken a somewhat similar view to that of Thoits (1982), referring to their approach as a social psychological cognitive conception. They suggest that "social support and social support resources should be viewed as related but distinct concepts" (p. 74). The former is seen as "a personal experience rather than a set of objective circumstances or even a set of interactional processes" (p. 74). These authors draw on Cobb (1976) delineation of support and to a lesser extent on Weiss (1974) formulation of social provisions, emphasizing the degree to which the individual feels loved, respected, and involved. This conception provided the basis of several measures developed by Turner and his colleagues. House (1981) argued that support is best approached in terms of who gives what, to whom, regarding which problems? He proposed that support is "an interpersonal transaction involving one or more of the following: (1) emotional concern (liking, love, empathy), (2) instrumental aid (goods and services), (3) information (about the environment), or (4) appraisal (information relevant to self-evaluation)" (p. 39). This list establishes the "what"; the "whom" might include a spouse, relatives, friends, neighbors, work supervisors, coworkers, caregiver and professionals. In short, House sees support in terms of problem-related social interactions with a broad range of people involving four major kinds of assistance. Shumaker and Brownell (1984) define social support as "an exchange of resources between at least two individuals perceived by the provider or the recipient to be intended to enhance the well-being of the recipient" (p. 17). A broad list of resources are noted including behavioral assistance, feedback, information, intimacy, and lay referrals (p. 22). Shumaker and Brownell point out that their definition suggests the need to consider the relationships of the actors and that it explicitly includes not just network members but allows that strangers and experts might provide support. Support is not limited to a stress paradigm but includes a broad outcome. Further, support is tied to 20

intentions; thus the actual outcome may be positive, neutral, or negative. Indeed, Shumaker and Brownell go into some detail in discussing the possible effects of the congruence or incongruence of participant perceptions. Lin (1986a) recently has presented two approaches to conceptualizing social support that have guided ongoing research conducted with her colleagues (Lin, Dean, and Ensel 1986). The first approach utilizes a synthetic definition, attempting to integrate views expressed or implied in earlier work. According to this synthetic definition, social support is "the perceived or actual instrumental and/or expressive provisions supplied by the community, social networks, and confiding partners" (p. 18). Note that three levels of linkage to the social environment are specified; these are reflected in perceptions of belonging, bonding, and binding, respectively. Two broad categories of support are distinguished: the "instrumental dimension involves the use of the relationship as a means to achieve a goal" (p. 20) whereas the expressive dimension "involves the use of the relationship as an end as well as a means" (p. 20). Thus Lin's synthetic definition distinguishes several layers of social involvement and two dimensions of support. Lin's second approach builds on social resource theory. Lin draws on Granovetter (1974) distinction between strong and weak social ties. She also distinguishes instrumental and expressive social action: action in which goals and means are distinguishable or not, respectively. Successful instrumental action benefits from access to weak ties. However, expressive actions serve to maintain rather than gain personal resources, a purpose best served by strong ties that involve persons with similar characteristics and lifestyles. Thus maintenance of mental health requires access to strong and homophilous ties. This second theoretical approach does not offer a definition of social support per se although the focus is on the inner layer of relationships (intimates and confidantes) and links to mental health are drawn. There are several striking features of these conceptions of social support. Each seems to make a good deal of sense, each is elaborate, and yet it does not require a logician to point out inconsistencies. This fairly representative sample of conceptions highlights social ties (Lin 1986a), exchanges (House 1981; Shumaker and Brownell 1984), and subjective appraisals (Thoits 1982; Turner, Frankel, and Levin 1983). They focus on support in the context of problems (House 1981), explicitly avoid this constraint (Shumaker and Brownell 1984), or emphasize functions related to ongoing social needs (Lin 1986a; Turner, Frankel, and Levin 1983). Most recognize several sources of support but distinguish these differently and appear to view the distinctions as being of great or little importance. All distinguish the form or function of support, but, again, do so differently, lending the distinctions greater or lesser importance. In a nutshell, these efforts to conceptualize support reveal how much progress has been made during the past decade, but they also reflect continuing and unresolved issues. I have no delusions about being able to lay all these problems to rest; however, in the next section I will present my own view on these matters -- if for no other reason than the reader's right to know an author's prejudices. The viewpoint outlined was formulated some six years ago, in its essentials, in providing a conceptual base for developing a set of measures (Vaux 1982). SOCIAL SUPPORT AS A METACONSTRUCT The view taken here is that no single and simple definition of social support will prove adequate because social support is a metaconstruct: a higher-order theoretical construct comprised of several legitimate and distinguishable theoretical constructs (compare Cook and Campbell 1979). Indeed, the failure to distinguish several constructs, particularly while the richness of the idea is implicitly recognized, underlies most of the problems plaguing social support research over the past decade. Three social support constructs are distinguished here: support network resources, supportive 21

behavior, and subjective appraisals of support. 1 These three conceptual elements are linked in a dynamic process of transactions between the individual and his or her social environment. Further, the sources, forms, and functions of support are recognized as multidimensional. Theoretical definitions of these main constructs, as well as others of relevance, are presented below. Important Constructs Support Network Resources The support network is that subset of the larger social network to which a person routinely turns or could turn for assistance (or which spontaneously provides such assistance) in managing demands and achieving goals. Demands and goals include both major and minor encounters: those that stand out dramatically from everyday life (for example, death of a loved one or completing a major project) and those that blend into everyday life (for example, a rebuke, car problems, going to a movie, and having an interesting discussion). Overlapping networks may provide specific kinds of support such as emotional, practical, financial, advice / guidance, appraisal, and socializing. Support networks are assumed to show stability both in size and composition except during periods of developmental transition (for example, going to high school, getting married, and retiring) or nonnormative life change (for example, divorce, disabling accident, and work layoff). Features of the support network -structure, composition, and relationship quality -- may influence its value as a resource, that is, its sensitivity, accessibility, and capacity as a source of supportive assistance. Support networks are a resource that can be drawn upon, but even relationships that are generally supportive may or may not provide competent supportive behavior on any particular occasion. The social support process often requires active help seeking on the individual's part. Such activity may be carried out with varying degrees of intensity, skill, and enthusiasm. Occasions on which supportive behavior is proffered or requested are termed here support incidents. These have the temporal and spatial limits of a specific interaction and may last minutes or hours. Support incidents are most easily identified in the tapestry of social life when a focal person has experienced an acute stressful event or displays distress. Note that this point reflects the current emphasis on stressful events and negative affect. A broader view would include the positive domain, benign events and positive affect. Although information from support incidents may play an important role in support appraisals, information from ongoing relationships and interactions may be important also. Supportive Behavior Numerous and diverse, supportive behaviors are specific acts generally recognized (by most members of a culture) as being intentional efforts to help a person, either spontaneously or upon request. These include both providing tangible goods and services and expressing affection and evaluation. Clearly, supportive behavior may take many forms and serve many functions. However, some six modes of supportive behavior reflect an emerging consensus: emotional, feedback, advice / guidance, practical, financial / material, and socializing. Despite good intentions, supportive behavior is not necessarily helpful; the outcome will depend on the amout, timing, and mode of supportive behavior that occurs, as well as on the relationship with the provider and other aspects of the context. Further, any given supportive act may have multiple consequences, in the short and long term, on affect and performance. For example, a friend's efforts to get an individual to confront a difficulty may promote negative affect but improved performance in the short term and be recognized as reflecting respect and caring in the long run.

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Support Appraisals Support appraisals are subjective, evaluative assessments of a person's supportive relationships and the supportive behavior that occurs within them. As such, they are the primary indicator of how well support functions are being served. Thus appraisals may take many forms including satisfaction, feeling cared for, respected, or involved and having a sense of attachment, belonging, or reliable alliance. Appraisals also may be global, reflecting an evaluative synthesis of a person's relationships with the network as a whole, or focused, reflecting a particular domain of network relationships (for example, spouse, workmates, or friends) or a particular mode of support (for example, emotional or practical). Overview Social support is seen here as a complex transactional process involving an active interplay between a focal person and his or her support network. The individual must develop and sustain network resources, subject to the opportunities and constraints of his particular life context. Often, he must actively seek assistance from network members and manage support incidents so that proffered supportive behavior meets his current needs. He must actively appraise his relationships with others, both in terms of ongoing interactions and those that occur within support incidents. These appraisals may lead in turn to efforts to renew network resources. Recognizing social support as a complex dynamic process is the first step in understanding its role in buffering the effects of stressors and contributing to individual wellbeing. THE PROMISE OF SOCIAL SUPPORT As a focal point for theory and research, optimism regarding the promise of social support reached a peak during the late 1970s. The topic showed great potential for integrating and advancing research in several disciplines concerned with psychological and physical wellbeing, most notably, social epidemiology and community psychology, but also gerontology, health psychology, social work, medical sociology, nursing, and health education. Among social epidemiologists, social support seemed to shed light on the distribution of illness, variations in psychological well-being, and the process of help seeking. Several decades of research on psychosocial factors in health and illness had yielded a motley set of influences, including bereavement, job loss, residential disruption, community cohesion, membership in particular religious groups, ethnic affiliation, and marital status. Clearly, psychosocial factors played a role in both the development of illness and the return to good health, but placing these diverse findings into a coherent theoretical framework was no easy task. Social support looked very promising as a common ingredient in this diverse set of factors (compare Cobb 1976). Similarly, social support might serve to integrate findings linking psychological well-being and disorder to psychosocial factors such as social involvement, isolation, social participation, and marital status (Brown and Harris 1978; Gove 1972, 1978; Leighton 1959). Further, surveys of psychological distress and help seeking among community residents, as well as more intensive studies of college populations, put in perspective the role of mental health professionals and highlighted the importance of informal sources of assistance (Gurin, Veroff, and Feld 1960; Greenley and Mechanic 1976). Finally, social support appeared a likely contender to resolve puzzles in an area of central importance in social epidemiology, life events. Research on stressful life events gained considerable momentum during the 1970s, becoming a central player in theories of illness, psychological wellbeing, and vulnerable populations (Dohrenwend and Dohrenwend 1974, 1984; Kessler 1979; 23

Rabkin and Struening 1976; Vinokur and Selzer 1975). Yet the link between life events and disorder, although consistently observed, was small in magnitude. Clearly, the relationship was modified by other psychosocial factors -social support seemed a likely candidate. These developments were reflected in community psychology and community mental health also. As psychologists sought alternatives to an exclusively intrapsychic view of etiology, social and environmental factors took on greater importance. Research on stressful life events and life transitions became an important part of community psychology (Block and Zautra 1981; Dohrenwend 1978; Dohrenwend and Dohrenwend 1981; Sandler and Block 1979; Vaux and Ruggiero 1983; Zautra and Simons 1979). The long tradition of theory and research in psychology on stress, coping, and personal resources (for example, Lazarus 1966; Rotter 1966; Sarason and Spielberger 1975) facilitated research on moderators of life events, including work on social support (Holahan and Moos 1982; Linn and McGranahan 1980; Sandler 1980; Sandler and Lakey 1982; Wilcox 1981). Perspectives on intervention were changing also. As the effectiveness, social utility, and underlying values of professional psychotherapy were called into question, public health models, prevention, and the use of nonprofessionals began to hold great appeal. Interest grew in the beneficial role that various groups of nonprofessionals, including paraprofessionals, community caregivers, and natural helpers, might play (Caplan 1974; Cowen 1982; D'Augelli and Ehrlich 1982; Durlak 1979; Young, Giles, and Plantz 1982). The natural helping involved in social support networks also gained importance (Gottlieb 1981; Hirsch 1979, 1980; Wilcox 1981). Further, research on social support held promise for the development of social interventions (Froland et al. 1981; Mitchell, Billings, and Moos 1982; Mitchell and Hurley 1981). Perhaps, interventions targeting social support might protect individuals as they faced stressful life events or difficult life transitions and milestones. The initial promise of social support has not been realized. It has not resolved confusion about psychosocial processes in illness and psychological disorder. Neither has it proved the key to understanding variations in vulnerability to life stress nor paved the way to effective social interventions. Yet if social support has failed to meet our expectations, it is because those expectations were too high and our views simplistic. A more critical examination of research on social support over the past decade certainly casts a pallor on the seemingly unbridled optimism of a decade ago. Yet, social support has been an enormous success in the sense that it has generated a flood of research. As more elaborate concepts and models are developed, the field continues to show promise in illuminating psychological and physical disorder, variations in vulnerability, and the process of psychosocial stress, as well as in suggesting alternative perspectives on the prevention of problems and the delivery of services.

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