CHAPTER A Familv SvstemsTreatment for the Impaired Physician BarbarqR. Cunningham Researchersin the 6eld ofalcobolisrn and addiction havecriticized lhe diseascmodel of treatnreDt,with its Darrow focus on tbc individual iDsteadof the family system (Bowcn, l97U; Kerr & Bowen, 1988;I-awson & La$'son,i998; Morgan, 1981;Wallack, l98l). Such criticisln is especiallyapplicatrlc to thc treatment of impaircd physicians and thcir families. Rcccntrcscarch supports the notion lhrl adultswho havegrorvnup iD farnilieswith addiction hdvc a tendencyto choosecareers in thc hcaltlr'care professions(Mallsky, 1999).Vailldnt, Sobowale,and McArthur (1972)rcportcd that physician vulnerabil ity to addiction corrclatcswitlr unmet personalneeds. According to their prospective study,doctorc werc morc likcly to cxperienceproblenrs with drugs and alcohol,require psychotherapy,and havcmarital problernstlran werenratched non-health profcssional coDtrols.ln fact,Vailla'rt ct al. notcd that son1edocto$ choosea medicalcarcer to help themseh,esby helping othcrs. Vtrillant et al. concludedthat thesedoctors, doggcd by their perfectionisnr,were dcdicatcd in the extrerneto the well being oftheir paticnts,to their own detrinrent aud often that of thcir fnnrilies. Gabbardand Menninger (1989)furthcr €oncludedthat plrysicianstelrd to be less happy in their marriagesthan those in mrny othcr professions.Physicians'long hours arc not thc 6drseof their nrarital problems,thcsc rcscarchersfbulrd, but rather, doc tors'cxcessirework rvasoften a resllt ol their dcsirc to run arvayfrorn facing marital tcnsions.Emotional renrotenessanci withholding of angcr are two ofseven attributes of physiciansidcnti6ed by Ellisand lnbody(1988), ln nn carlystudy, Martin and Bird (1959)chardcterizcd thc troubled nredicaLmarriage as Lhe"lovc-sick wile" and "cold sick" husband.l hc notion that relatitxrshipdifficulties !lnderlie chcmicaldependency in physiciansis additionally sopported by the finclingsof Angres, Mccovern, Rawal, and shaw (2002),rvho fbund the pcrcentageofphysicians suffering from comorbid psy chiatric disordersor marital discordto be 60.370. 30t 302 c Lrnrn,3 - Ir his fcvie$'of thc psych{rso.ialf'rcl{rfs conlril)LLtirlg lo phvsi.i.rnrclcliction, CooDlbs( 1996)l;und I h.rtphysicitlns x'erc gcncrally ignomnt ol lhc delcloPnrentalaD(t intcrpersonald1'namics of addiction.I\'lore scYcre Drrlital dilllculties huvr rlso bcfr) l;Lrn(lLo bc highlycorrclrted with physicirnxddictn'rr (NIcCovcrn, An$rcs, & Leon, 1998).IioL)b (1998) norc{l that mcdical schools lypicilly do not i|rclLrdelf.rining in alco- holisn ard rddictior.It isalarDring that physiciaDs .fc nol trainrdto recoS|iz€ or tfcnl signsandsynr on1sin lheirp:rti.rrtsorinthclnselvcs. 'fhis chirpterprcscnts a tanrilys,vst€ns lfcatment li)r lhc inrPrircdPhysicial1 bitscd upon Bowcn Famil,vSysterrs Thcory (BlrSl).Corrccptualizing lrcatnlenl ofthe inr pailcdphysiciaD fro .rperspecl ivc that iDljlrdes thc PurLncrshilis the focLrsflorr Lhc in(lividualpcfspeclivc churacterit ccl by thc diserscnxxlel of tfrrtnlent lo x sysl.n\r focUslhat l(lclrcsseslhc llrultiplcvurirbles withir lhc physiciinliimily rhul can con tributcto addictionand keepil irlive.Addiclion is secrnot asrrr illrljvidurrldcficierlcl' (\v.,llack,l98l), but rs the resulrot ntult\nc influencc's.Larvson and l..rNson(1998) conctLrrvith thc needto conceptLralizeaddictir)o .rs x prcblen in relationshiPsyst.'rns. 'fhr)' citcl\4organ (1981), !\,llo lhcorires th.rl lhc diseascntodel "pxrvidcs r n out lor so' .ictl' in deilingu'ith sfrioussoci.rl proLrlcurs b,v crerlir)g a ileed1o treirl thc indiYiduirl irodtherebv lcgitimizcs thc problemas b.rscd !n th€ indi!iduall.l(h€r thil'r in thelaf$cr systclnol sociil rclations(the flnrily, the schoolsystcm, thc church,the conrlnunit),)' 1t. 360). l hus,irr licuo1 r rcductionisticlircus,lrc.tlrrrcnl shoul(l iclcntif,v lhc syslenri. .rndmalad.rptiYe fan)il)'pnltcrns that are lrnnslnillcd througlt urrltip{e Scncrations. A brorrdcr,fanil,v-oricnted lpproach is cspeciallyirrrPortrrll lor inrpaircdphysi ciirnsbecdusc th€y LcntlLo hav,-'ilctached intcrp€rsonrl slylcs (Sotile & S('lile.2000), au)idanceol intensccnroliolrs (l\4cvcrs, 1994), a slrcssfulpra.ticc (lalboll & liallegos, 1990),an(l cnsy a.c.s\ to rlirr.oti.s.Cllini.itlns rre encourrgedto conccPtullizccherrri- crl dcpendrrrccas a likclyfellcction ol scriousrclationslrip issucs in thecloclols noclcrf rnd cxtcldcil l:rnlilies,l)chreellind wiLlrirrgcncr.rtiorrs (Bowen, 1978). {lorrverscl), Lrs- ing rn indivnlnl tLe.]rnrcnt appt on(h Nith rbeinpaitcd phvsieianis likc' lhrow;ng hi,rr or lrrr out ol .r\\41ite\\,irter currcnt, res s.itirlirlghirn ('r hef,ind thenlhr(,wing hinr of hcr rightbi(jl( into thc lorrenlirlwaters. 'lb underlincthc vfracit\'ol this nrcl.rpho,f,tlboll (1987)JirLrnd in artanal|sis ol i(X)phlsi.irns, foll(xvf(l tirf 4 !crfs subscqLrcnt!o tl(irtIncnt.th.rl the reln|scrate $'as (lrarraticallybighcr vrhcr th€ spolrs€(,,rs Lrnilvolvctl ard Lrntfr.rtccl.Sirrrilrrlv, r tc cfnt studyol'.rdLrll opirrlc users irrclicate(l bctt€r oulcornes lbr lhoscrecci!ing fanrily I rcatlnentthnn for thosc rccei\ ing l\,o indi!idurllI birscdinlcrycnliors, prrl jcularl!li)r rhoseLivins rvith r prrlncr (Yin(loli,Eislef, Itobbins, \'lullei dy. & I)ar€,l(X).]). Lr ln.r, inrf.rireclphvsici.rns and thcif rrmilies,lilic rny olhcr lJnril)'sLrlliring rvith chenical dcpcndencc,crnrot bctreilcd elllclively wilhout a lhofoughtrs\tssnlcnt trrr(i lreatncnl ol dystirn.rion"ldyn:rnrics $ithin (hc ranrilt.A parailigmshilt ho indiyi(lualtrerr nrcntstypilicd b,v thc diseaseunxlel Lo .r tlnrillr systerrrs tfealrrrcnt xs lyfilicd b,vltfs I ollcrsanopl)o|tuDilyloflasli,rgchrngcth,rlSocstlecpcrthanplacing,tllrtnclAiclonLr gapingwound. IiFST,wit h its!rt ol interloching principles, prrrvidcs a roarlrllap for sr-\temjc tfctrl lrc l. Tr€rlrrrcntshills lrun licusingon thc paticntlo clisco\'cricsfegar (ling whrrl 1)rrfL c,rchl.rnrillrrrcmbelpl,rvsinnrnintairlirgrllcproL)lcrn(l)rpen),1990).ThffatieDlhcl|s k' (reitc r hnrill dirgr':Lmcorcring thrcc or nlorcScnciation\ rs l,n|t cil.r cognilivclr A F^Mtrysysrdt Tr(^rMrN' toR u. tMprrRrDPHysrcr^N ! JU5 lbrrscdcllbrt to viewthc l.rIn il)'s cnlotional pr(,ccss rcross time (Kerr& lnNcrr,1988 ). Altcr.rnorgarized efforl ri) (t)llcct ftrcts and idcDtilyp.rttenrs of familytunctioninS, the clicnt(or clicnts)in tretlrnrentis irsked to idenlilyand rrke responsibilirylbr hisor her. plrt in thc mairtenanceol thc synrpton. An inrportantpart oflrcotrnc l invoh.€sbridSirrglhc distrnce betlveen l.rnrill'rr)cnl 'ticrrnrcDr bersrml Icpairing thc cnn)ti(nrnlcutofIbetweeD Scncroti(nrs (Bo\{en, 1978). involvesactive efforts by thc timily (o discoverhow rchrionshipsfincriouerl in prcvi ors gcncrllins, in ordcrto understandhorv prst relrtionshipsinflue|cc cLrrrenr rcla tionships.l)rticular;ttorli(n) is prid lo identifyingthc ovcrfunctiolingolone n)cnbcr in lclatiorrto the undcrfunctioningofanother (l)(^t,cn, 1978; Cilbert, 199,1). wilh rhc lrtnrilydiagrrm asa blucprintt(' 8uidefurthcr tliscovery, rhcrapy is crnrccprunlircdas thebcgir)ning ofa lifelor8journey bward incrcirscdnrv.rreness ol how c'nmtion,rl tbrccs nnd r\icly aretransmi[ed rcross geDeratioDs (Kc & lJowen,1988). The Promiseof BowenFamily Systems Therapy ln thc lrie 1950s,l)r. J\'lurravllowcn obscrvcd rhrr secnringlvcurt'd schizcryhrcnic pa ticntsrchpsed upon rclunriDghonle lo thcir tli|lrilirs5oon.llicr the,v rvere dischalgcd lrnn iopnlrenttrealmcDt pr1)!ir.rnrs (Uoit'cn, l97lt). AItcr obscryingtlris phcnontcnon, I)r. lJolcn <lecicledto try hospitirlizingthe schizophrenicalLrng rvith his or.hercntirc lrnrily. Obtainingmore l.rvorablcresults, Bo$icr) canrc to concluclcrh.rt rhe tirnrily, rrlhcr lhilr the irdividutll,I'is thc ploperuril ol trcalnrcnt.His Lrniquc.rpprrrach s. sunrc{llhnl all familiesopclirtcd hoD a highly cnrotionirll,vinterdcpcnilcDt posirirn ((c' ll(\vcn,l9SS), mrirning thit the nroreintcrdr'pcndcnt the famil! nrcnrbersirre, ' "\ the nx,fc highlyrirsed erch individualis with rhf orhcr (Kerr& Bow{n, t9s8).lusccl i;rmilvnrcnrbcrs have littlc irul,nronrvfrom onc rrrolhcr.ln ertrenrclvtuscd fanrilic:,, nrenrbelsarc or.crly iDvolvc(lwith one another. ll rrrc frmilv nleDber hrs nn itch, li" cxarnplc,cvervone clsc ill thr ll nrilyscratches. lJowcnposited thdt thc Inorchighly fuscd thc lirnily sysLc.rnis,the nrorcvulucrable lhc cnlifc l'ilnily is Loclcvckrping svnrptorrs th.r1 ollcr nrc carricdby only onc lirnrily nrfrr)l)crlin the\!hoic syncrr). Il('\\cn (l978) chrr,rclcrirfd Lhis highly fuscd l,rnil,v unit rs rn un(iifferenlialcdqrr nuss. l:.rmilicscoul(l in(rc.rsc thc leyelof thci''.('llccti\'( h|.llrh,hrwcn hlpothcsizcd,bv increasingthc lcvelol irr(lividualir,vot c.,chnrcnrbcr (KLrr & ln^!en, 1988).In.sscnce, individurrls coulcl (ho,)sc whcn to be scpur.,rcantl 1\4renlo rcnrainconnc.kd (Kcfr & Borven,l9ltlt). If flnril)' ncnrbcrsure viewcrlrs highlyinlcrdcpendent,the|lidentifyingrnultiplcvnfinblcsloirccoLrnttirfsymlrtonrsrvill Lrcnorc likclyto effectrcll ehirlgc. 'lhischaptcrhypotbrsizcslhtrl$4renatreatn)cnlpr1)locol ri s to chtrngclhe srflr.- 1,,'r'olrr s),rtu'/rinstead ol irirnirigto chaDgelht' htlttl(orsof un inlivirlrrrrl,a p0sirivr trcntDrcnloot.ome is n]orc likclv to belolg ternr.'lhissecond ordclchirncc r)reans thar lhc g.rmtilscll has been irltrrc(l rnthcr than only ihr ftrlcs(l Inrper& (}pdc\ i1d.l(.1901. \{ithirr rhc world!icwof l}fs 1,I hcr.rpistsare ollircd .' disrinctl,vdiftefcnt .rncl Promis inBrltpr'{)r.lr lo treirtirrgonn)lionrl problcrls such .rs chcnical abuse and dcpcntlencc. 3O4 crrrrrn,3 - l3o$'en(1978)