Implications of a Family Systems Orientation for Preventing Psychiatric Hospitalization
The present study evaluated the implications of a family systems approach for preventing psychiatric hospitalization by comparing the behavior of field clinicians who professed a systems view versus clinicians who held more traditional nonsystems views. The focus of the investigation was the clinical assessments and decisions of 31 clinicians who worked at five Virginia public mental health centers as they prescreened (i.e., evaluated need for inpatient treatment) 171 candidates for hospitalization. Q-technique was employed to determine theoretical orientation. It was hypothesized that clinicians who held a systems view would be more likely than nonsystems therapists to evaluate and attempt to organize clients' social context and to contact and organize the input of relevant professional helpers. They were expected to be less likely to involve physicians, use medical or psychodiagnostic procedures, or refer clients to sheltered treatment/support facilities. Most importantly, they were expected to recommend hospitalization less often and emphasize aspects of clients' social context in their decision-making. If hospitalized, their clients were expected to have shorter stays. The results indicated that clinician behavior, clinician decision-making, and client disposition all reflected elements of systems and nonsystems views. While systems therapists placed greater emphasis on approaches that were consistent with their point of view, they also employed methods and were influenced by factors (eg., symptom severity, diagnosis) that were inconsistent with professed orientation. Further, they hospitalized clients no less frequently than nonsystems therapists and their clients spent the same amount of time in the hospital during the 30 days following prescreening. The results are discussed in terms of the exportability of the method outside the training institute.
Family systems orientation, Psychiatric hospitalization, Clinicians, Psychoanalysis and Psychotherapy
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