Treatment issues in the group psychotherapy of addicted physicians

Author(s): Silvan, M.

Journal/Book: Psychiat Quart. 1999; 70: 233 Spring St, New York, NY 10013-1578, USA. Human Sci Press Inc. 123-135.

Abstract: While there has been a great deal written about impaired physicians, few articles have been devoted to the clinical issues that arise in the treatment of these patients. Many are summary reports from state medical society programs (Canavan, 1983; Casper, et al, 1988; Gallegos et al, 1992; Shore, 1987). Other articles report demographic data or describe prevalency rates (Brooke et al 1993; Hughes et al, 1992, Waterhouse et al, 1997). Those that discuss treatment tend to focus on outcome but do not describe in detail what actually occurs during treatment (see Herington et al, 1982, Gallegos et al, 1992, Benzer, 1993). This is a significant omission in light of the fact that a number of authors note that physicians are in some respects different than other addicts (Kleber, 1984; Smith, 1978; Talbot, 1996) and require some modifications in the treatment that they receive. While several articles have been written on the related topic of how to treat psychiatric problems in physicians (Gabbard, 1995; Stoudemire and Rhodes, 1983; Meissner and Wohlauer, 1979) clinicians have not articulated how physician addicts present in treatment, the special problems they have or the types of dilemmas they pose for the clinician. This article will highlight some of the psychodynamic conflicts that predominate in this population and describe particular areas of resistance that emerge in the therapeutic relationship. As group treatment is the modality most often recommended for this population there will be a special emphasis on the ways in which these resistances emerge in group. In some respects, many of the obstacles to conducting meaningful psychotherapy with this population are related to the patient's identity as a physician. If these are not appreciated and addressed the treatment can remain shallow and take on an ''as if'' quality. In addition, because being mandated can complicate the treatment in a variety of ways we will also address the ways is which this process produces its own set of problems for both the patient and the therapist. Finally, we will discuss some of the more common countertransference reactions that can arise in working with these patients as it is our experience that this is a particularly interesting area of exploration and one that has been virtually ignored in the literature.

Note: Article Fayne M, 155 E 91st St, Suite 1B, New York,NY 10128 USA

Keyword(s): SUBSTANCE

Zurück | Weiter