Over the last 20 years the use of medication in combination with psychodynamic psychotherapy or psychoanalysis has shifted from an infrequent occurrence to common practice (Roose, 1995). Paralleling this shift, attitudes toward medication have changed from viewing this intervention as disruptive or an addition of last resort to a welcome aid to the analytic process.
This rapid change, however, has created difficulty, both theoretically and technically, in the integration of medication use into the analytic setting (Busch, 1998; Roose & Johannet, 1998). Although these treatments can work well together, there are potential pitfalls that can disrupt the effectiveness of combining treatments. The intent of this book is to provide information on how to work with medication theoretically, clinically, and technically in the context of a psychodynamic or psychoanalytic treatment.
Toward this goal, we will describe the evidence that this change has taken place, examine the factors that have led to this shift, and review the issues and questions about combining these treatments.
PSYCHOANALYSTS’ SHIFTING VIEWS OF MEDICATIONS
Early concerns about the use of medication in a psychoanalytic treatment focused on several issues (Roose, 1995). Psychoanalysts feared that medication would reduce motivation for change by easing negative feelings that led patients to pursue treatment. In addition, anxiety was believed to be of particular value because it indicated the presence of psychic conflict, thus aiding the analyst in pursuing the unconscious sources of the patient’s symptoms. In this sense, the presence or onset of anxiety could be looked at as a positive sign rather than a detriment because it suggested that conflicts were being addressed.
Since anxiety was an indicator of conflict rather than a cause of the patient’s problems, it was not necessary to treat it with medication. In addition to potentially derailing valuable negative affects, medications were seen as possibly undermining the patient’s sense of autonomy and self-esteem.
It is clear that one will not give pharmacotherapy to a patient unless one believes that the symptoms the patient presents and the disease process producing the symptoms cannot be mastered or dealt with by the patient in psychotherapy at that moment in time or space. If this assumption is not correct—if the patient can, in fact, with the help of the physician, correct and master the intrapsychic problems causing the symptoms and the suffering—then the psychotropic medication … is not really needed … The patient may perceive the act of taking the medicine as proof that he cannot handle his symptoms or problems without it.
2. Theoretical Bases of Combined Treatment
3. Getting Started With Medication
4. The Meaning of Medication
5. Clinical Values of Combined Treatment
6. Approaches to Treatment: The Prescribing Therapist
7. Split Treatment
8. Combined Treatment for Depressive and Anxiety Disorders
9. Complex Cases References
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