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. Two extensive case histories are presented to illustrate both theoretical issues and the treatment process.     

Stability/Instability in the Alcoholic Marriage: The Interrelationships Between Course of Alcoholism,Family Process,and Marital Outcome

Thirty-one alcoholic families who were originally studied in home, multiple-family group, and laboratory settings were reassessed two years later to determine course of alcoholism and degree of marital stability. This paper presents data comparing baseline alcohol consumption and family interactional behavior at home with subsequent alcoholism and marital stability outcomes. Findings suggest that the relative degree of stability/instability in these marriages is best understood as a function of the “goodness-of-fit” between the relative predictability of drinking on the part of the identified alcoholic and the family's characteristic pattern of interactional behavior at home.     

Family Climate and Expressed Emotion in the Course of Alcoholism

Family-based predictors of relapse were examined in 100 alcoholics who participated in a 12-week treatment program with 6-month and 18-month followups. “Expressed Emotion” (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self-reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6-month followup and 30% at 18-month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: “Critical Comments,”“Emotional Overinvolvement,” and “Warmth.” A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the “survival function” of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.     

Family Process as a Mediator of the Negative Effects of Parental Alcoholism on Young Adult Dating Relationships

The effects of parental alcoholism on young adult dating relationship quality (trust, intimacy, commitment, and satisfaction) were considered in the context of the mediating variable of family process (cohesion, conflict resolution, and family competence). A model was tested with a sample of 287 young adults (95 were adult children of alcoholics) that suggested that healthier family process mediates the negative effects of having an alcoholic parent on dating relationship quality. Structural equation modeling results showed that the model fit the data. Young adults from alcoholic families in which family process was less negatively affected by parental alcoholism were less likely to report lower dating relationship quality than those from families in which family process was more negatively affected by parental alcoholism. Parental divorce was directly related to lower relationship quality. Clinical implications for working with young adult children of alcoholics are discussed.     

A Spontaneous Request for Treatment by a Group of Adolescents

In this article, we build on our clinical knowledge in working with the adult children of alcoholics, examining the importance of the “alcoholic” family, past and present, to the current functioning of adults who grew up in such an environment. Specifically, we focus on key issues related to the development of family transference in the group therapy setting.     

Psychologie en première et en troisième personne : de la « psychologie concrète » à la psychologie clinique

This article presents some basic concepts proposed by G. Politzer, articulated around the concept of “tragic life”, in the literary sense of the composition of a complex of events, actions and people, unity and meaning can only be realized in “first person”. In this context, defining the perimeter of legitimacy of clinical psychology, a “fact” specifically psychological necessarily corresponds to an act which takes existence and feel like segment of a human drama, as an effective act of the singular individual. Critics resulting analyzes relate to the abstract and formal perspective of scientific psychology, which considers classes of facts rather than facts, designing them as entities in themselves, the external I they are demonstrations. The explanatory model which necessarily carries out field of concrete psychology since its causalists schemes have lost sight of the act “first person”. And psychologists would not have noticed that “I remove the psychological facts is destroying them.” (G. Politzer). The person, in his psychic dimension, can only be understood from the person, which makes it possible to specify the field of clinical psychology, and more generally, of any clinical approach.     

A Developmental Model for Family Systems

This paper reviews the historical context of concepts of development and some of the problems of applying them to family systems. A model of family systems development is presented that emphasizes changes in family shape through the individual life cycle. Some clinical uses of the model are described.     

The social concept of disease

In the discussion of such social questions as “how should alcoholics be treated by society?” and “what kind of people are responsible in the face of the law?”, is “disease” a value-free or value-laden notion, a natural or a normative one? It seems, for example, that by the utterance ‘alcoholism should be classified as a disease’ we mean something like the following: the condition called alcoholism is similar in morally relevant respects to conditions that we uncontroversially label diseases, and therefore we have a moral obligation to consider alcoholism a disease. So there are grounds to think that, in the discussion of social questions, our concept of disease is strongly value-laden. However, it does not follow that the medical concept of disease is likewise value-laden. In this paper I distinguish between the medical and social concepts of disease, arguing that the naturalist-normativist debate is concerned with the former, but not the latter. Therefore, we need not settle the naturalist-normativist debate in order to conclude that the social concept of disease is value-laden.     

Couples at risk for transmission of alcoholism: protective influences

A two-generation, sociocultural model of the transmission of alcoholism in families was operationalized and tested. Sixty-eight married children of alcoholic parents and their spouses were interviewed regarding dinner-time and holiday ritual practices in their families of origin, and heritage and ritual practices in the couples' current generation. Coders rated transcribed interviews along 14 theory-derived predictor variables, nine for the family of origin and five for the current nuclear family. Multiple regression analysis was applied in a two-step hierarchical method, with the dependent variable being transmission of alcoholism to the couple. The 14 predictor variables contributed significantly (p less than .01) to the couple's alcoholism outcome. A general theme of selective disengagement and reengagement for couples in families at risk for alcoholism recurrence is discussed.     

Externalizing symptoms among children of alcoholic parents: Entry points for an antisocial pathway to alcoholism

The authors examined heterogeneity in risk for externalizing symptoms in children of alcoholic parents, as it may inform the search for entry points into an antisocial pathway to alcoholism. That is, they tested whether the number of alcoholic parents in a family, the comorbid subtype of parental alcoholism, and the gender of the child predicted trajectories of externalizing symptoms over the early life course, as assessed in high-risk samples of children of alcoholic parents and matched controls. Through integrative analyses of 2 independent, longitudinal studies, they showed that children with either an antisocial alcoholic parent or 2 alcoholic parents were at greatest risk for externalizing symptoms. Moreover, children with a depressed alcoholic parent did not differ from those with an antisocial alcoholic parent in reported symptoms. These findings were generally consistent across mother, father, and adolescent reports of symptoms; child gender and child age (ages 2 through 17); and the 2 independent studies examined. Multialcoholic and comorbid-alcoholic families may thus convey a genetic susceptibility to dysregulation along with environments that both exacerbate this susceptibility and provide few supports to offset it.     

Home Brewed Alcohol use Among High School Students in a Rural South African Community

This study investigates the use of home brewed alcoholic beverages among adolescents in high schools in a rural community in South Africa. There is much concern about alcohol misuse among young people and very little information exists on alcohol produced by the informal liquor industry in South Africa. A total of 1600 high school students participated in the study. The prevalence rates for past year use of home brewed alcohol was 22.2%. There was association between home brewed alcohol use and correlates such as “lived in city”; “raised by both parents”; “repeating school year”; “poor scholastic progress”; “absenteeism” “getting into trouble”, “arguing with parents/friends”; “neglecting homework”; and “recreation/leisure”. The prevalence rates for home brewed alcoholic beverages use in this rural schools calls for more research that focuses on home brews which could lead to the development of appropriate health promotion intervention in schools.     

Marital Interactions of Male versus Female Alcoholics

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the “no-drink” session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no-drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.     

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 past 25 years. It also offers potential explanations for the reluctance of family therapists to engage this problem more actively.     

Revisiting Wittgenstein on Family Resemblance and Colour(s)

We argue that all general concepts are family resemblance concepts. These include concepts introduced by ostension, such as colour(s). Concepts of colour and of each of the specific colours are family resemblance concepts because similarities concerning an open‐ended range of colour or of appearance features crop up and disappear. After discussing the notion of “same colour” and Wittgenstein's use of the phrase “our colours”, we suggest family resemblance concepts in one tradition can often be extended to family resemblance concepts in another tradition, illustrated by Wittgenstein's use of the words Spiel and “game”.     

Spirituality: The Key to Recovery From Alcoholism

The authors suggest that a condition of “negative spirituality” underlies and sustains alcoholism, and perhaps all addictions, and that a secure recovery is not possible unless a “spiritual awakening,” such as is envisioned by Alcoholics Anonymous (AA), is achieved. A broadly applicable conceptual model of spirituality is inferred from the AA 12-step rehabilitation program.     

BEHAVIORISM: PART OF THE PROBLEM OR PART OF THE SOLUTION?1

The form frequently taken by behavior-modification programs is analyzed in terms of the parent science, Behaviorism. Whereas Behaviorism assumes that behavior is the result of contingencies, and that lasting behavior change involves changing the contingencies that give rise to and support the behavior, most behavior-modification programs merely arrange special contingencies in a special environment to eliminate the “problem” behavior. Even when the problem behavior is as widespread as alcoholism and crime, behavior modifiers focus on “fixing” the alcoholic and the criminal, not on changing the societal contingencies that prevail outside the therapeutic environment and continue to produce alcoholics and criminals. The contingencies that shape this method of dealing with behavioral problems are also analyzed, and this analysis leads to a criticism of the current social structure as a behavior control system. Although applied behaviorists have frequently focused on fixing individuals, the science of Behaviorism provides the means to analyze the structures, the system, and the forms of societal control that produce the “problems”.     

家庭抗逆力理论在风险应对领域的应用：演变、价值及挑战

家庭抗逆力理论是近年来风险应对研究领域中被引最高的理论之一。该理论的提出源自McCubbin等人对军人家庭应对战争危机的观察与思考,得益于早期学者对家庭压力和家庭系统理论的探究。经数次修订后,该理论经历了由静态特征到动态变化的发展过程,形成了一个具有较广泛内涵与外延的理论体系。其早期应用集中于创伤修复、家庭压力应对等主题,之后涉及复原力等更丰富的研究议题,已成为临床干预工作的实践导引和COVID-19大流行以来国家和社会、家庭和个体层面“危机事件—适应能力”关系的重要解释机制。其应用面临来自元理论研究、方法学及跨文化与社会变迁观点的挑战。未来研究应明晰概念与整合模型、使用混合方法与制定评估指标体系、强化家庭抗逆力理论的本土化研究与构建中国特色家庭抗逆力理论体系。