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Biomedical subjects

P Steinglass

Publications and source records attributed to P Steinglass.

At least 37 records · Page 2Linked to original sources
PubMed1981

The alcoholic family at home. Patterns of interaction in dry, wet, and transitional stages of alcoholism.

Thirty-one alcoholic families were observed in their homes on nine separate occasions over a six-month period. During each occasion, behavioral observers made systematic recordings of interactional behavior using the Home Observation Assessment Method, a method that concentrates on the family's style of regulating its home environment. Three distinct patterns of home behavior could be identified using univariate and multivariate statistical analyses. Each pattern was associated dry, or transitional phase. This suggests that these families manifest characteristic family-level patterns of behavior in their homes at different stages in the course of chronic alcoholism. The critical issue was the relative rigidity vs flexibility of behavior. Families in either stable wet and transitional phases proved to have rigid patterns of behavior; those in the stable dry phase had flexible patterns. The findings provide an initial insight into how families manage a chronic disease process in their home environment.

Adult↗
PubMed1980

A life history model of the alcoholic family.

Research and clinical interest in the alcoholic family has tended to outpace the development of family-oriented conceptual models of alcoholism. A family development perspective has been almost totally absent, despite the chronic, longitudinal nature of alcoholism. A life history model is proposed that uses the concepts of the "alcoholic system," family homeostasis, and the "family alcohol phase" as its building blocks. Chronic alcoholism tends to produce distortions in the normative family life cycle. These distortions and their clinical implications are discussed, using four case histories as illustrations of the concepts proposed. The model is also examined in the light of current research findings about the alcoholic family.

Adaptation, Psychological↗
PubMed1980

Predicting which patients will be discharged against medical advice: a pilot study.

Studies of patients signing out against medical advice (AMA) from a psychiatric service have been retrospective and inconsistent or contradictory in their findings. The authors report findings from a prospective study in which data from a brief structured interview of patients at the time of admission were used to predict subsequent AMA behavior. They achieved 80% accuracy. Critical variables centered around the nature of the "treatment contract" as perceived by the patient: AMA patients never intended to stay in the hospital for more than a few days.

Adult↗
PubMed1980

Assessing families in their own homes.

Assessment of the family in its own home provides important information about the family's style of regulating its internal environment. The author presents data from a study of families in which one of the spouses was alcoholic. These families were observed at home on nine occasions over a six-month period; the technique used, the Home Observation Assessment Method, measured dimensions of family behavior associated with routines of daily living. Dimensions of home behavior were highly correlated with traditional clinical measures of psychiatric symptomatology, severity of alcoholism, and family boundaries.

Alcoholism↗
PubMed1979

The home observation assessment method (HOAM): real-time naturalistic observation of families in their homes.

The Home Observation Assessment Method (HOAM) is a new method developed to carry out objective coding of family interaction over extended time periods in a home setting. It is a computer-compatible coding system that permits on-line data reduction of interactional variables emphasizing contextual and structural dimensions of family behavior. To date, the HOAM has been applied to the study of 31 families observed for a total of over 250 sessions. Initial analysis of data from these sessions indicates that coder reliability is high and that the HOAM successfully measures dimensions of family behavior independent of architectural aspects of the home setting. Preliminary findings also indicate that although families differ dramatically along the interactional dimensions measured by the HOAM, all families studied spent remarkably little time in decision-making behavior, suggesting that behavior in the home is predominantly "maintenance-oriented."

Child↗
PubMed1977

Observations of conjointly hospitalized "alcoholic couples" during sobriety and intoxication: implications for theory and therapy.

This paper presents clinical data from a research study designed to examine the relation between alcohol consumption and interactional behavior in "alcoholic couples". The central innovative feature of the study was the simultaneous admission to an inpatient setting of up to three couples, one or both members of which was alcoholic. The in-patient experience was part of an intensive, six-week, multiple-couples, group-therapy program. During hospitalization couples were encouraged to reproduce as closely as possible their usual drinking patterns and interactional behavior. Therapists utilized observations of interactional behavior during intoxication and sobriety to formulate central interactional and psychological issues for each couple. The authors utilized these same observations to develop the interactional model of alcoholism in families that is presented in detail in this paper. This model is an extension of earlier work delimiting an interactional theory of alcoholism based on general systems concepts.

Adult↗
PubMed1976

Experimenting with family treatment approaches to alcoholism, 1950-1975: a review.

The attention given family therapy approaches to alcoholism has been disproportionately low in relation to the magnitude of alcohol abuse as a clinical problem and its acknowledged impact on family life. Although the literature to date is limited and most studies should be characterized as pilot in nature, preliminary results have enthusiastically endorsed family therapy approaches to alcoholism. This critical review assesses the existing experimental and clinical literature of the pase 25 years. It also offers potential explanations for the reluctance of family therapists to engage this problem more actively.

Alcoholism↗
PubMed1975

The simulated drinking gang: an experimental model for the study of a systems approach to alcoholism. I. Description of the model.

This two-part paper deals with an experimental model for studying interactional behavior from a systems point of view. The experimental model incorporates a research strategy utilizing both a token economy and the simulation of a naturally occurring clinical phenomenon, the alcoholic drinking gang. The model is primarily geared to do two things: a) study the changes in clinical behavior that occur when experimental conditions are manipulated to facilitate the formation of the behavioral "system" as opposed to experimental conditions which interfere with system formation; and b) build into the model tasks which produce measurable performance data as a method of monitoring behavior deemed essential for the successful development of an operational system. The experimental model involved admitting up to six alcoholic individuals to a research ward specifically designed for studies utilizing experimentally induced intoxication. Each study was divided into a 7-day predrinking period, a 10- to 14-day drinking period, during which time alcohol was available to research subjects, and a 5- to 7-day withdrawal period. A token economy was established which allowed for the following essential features to be present: a) a group of chronic alcoholic individuals who desire to go through a drinking experience together; b) the pooling of resources in order to purchase alcohol; c) rules established by the group for the sharing of whatever alcohol becomes available to the group; and d) the opportunity to earn money for the purchase of additional alcohol after the initial supply runs out, in order to keep the group drinking experience going. All "money", or tokens, could be earned only via successful performance at the Cooperative Task Device (CTD), a cooperative, two-person game, and tokens could be utilized to purchase three types of commodities from an automated dispensing machine, alcohol, cigarettes, and television time. Automated data recording provided detailed data about CTD performance and commodity-purchasing records. The discussion centers around difficulties inherent in a simulated model of natural behavior. It is pointed out that laboratory simulation vs. natural setting, as the preferred site for carrying on behavioral research, remains an active controversy, and the arguments on both sides are presented. Difficulties inherent in doing "systems" research are also discussed. A series of alternative hypotheses to explain behavior within the simulated drinking gang are listed, and the data that would be necessary in order to substantiate these alternative hypotheses are also listed. It is maintained that the simulated drinking gang is an advantageous experimental model in that it closely approximates the basic criteria of the naturally occurring phenomenon, while at the same time allowing subjects a range of behaviors, each of which substantiates a different hypothesis about the central organizing feature in alcoholic groups.

Alcohol Drinking↗
PubMed1975

The simulated drinking gang: an experimental model for the study of a systems approach to alcoholism. II. Findings and implications.

Data analysis involved data from three different sources, the Cooperative Task Device (CTD), the commodity dispensing machine, and a Stephenson Breathalyzer (for blood alcohol determinations). Data were analyzed on three different levels: individual, dyadic, and whole group. Results are presented for work performance, role performance, commodity purchase patterns, comparisons of work and purchase patterns, and correlations of work time with work efficiency and blood alcohol levels. Marked discrepancies in individual and dyadic work performance were found in all three groups and there was no relationship between chips earned and chips spent. The "drinking gangs" seemed quite willing to tolerate "freeloading" when it occurred. Role performance at the CTD was inconsistent; individuals for the most part fluctuated in their role performance rather than remaining in a stable role, e.g., leader. There was no demonstrable correlation between work time at the CTD and either work efficiency or blood alcohol levels. Lastly, dyadic formation vis-à-vis work performance showed considerable fluctuation over time. Group members did not pair off into consistent and stable dyads when playing the CTD. These findings are discussed from the point of view of the series of alternative hypotheses presented in part I. It is maintained that the data are inconsistent with all of these hypotheses, but that they do help to substantiate and are consistent with the concept of the "drinking system."

Alcohol Drinking↗