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Chapter 5. Combining Psychodynamic Psychotherapy With Medication

Jerald Kay, M.D.
DOI: 10.1176/appi.books.9781585623648.368017

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Excerpt

The age of psychopharmacology was not met with enthusiasm by all. In the last half of the twentieth century, many psychoanalytically oriented clinicians maintained that medications somehow submerged important conflicts and feelings, making psychotherapy and psychoanalysis less effective. Another concern was that using medication would impart to patients a sense of being exceptionally ill, making them less suitable subjects for psychotherapy or psychoanalysis because they would then have inadequate ego strength. Some therapists even argued that assisting the patient through medication eventuates in symptom substitution wherein new symptoms appear as the initial symptoms subside. The possibility of premature treatment termination because of immediate symptom relief was also discussed. Analysts acknowledged that although medication could be effective, ultimately such treatment would never address core conflictual and characterological issues. Others expressed concern that the analysands would view the introduction of pharmacotherapy as a reflection that they were unresponsive patients, especially if medication were introduced well into the analytic treatment.

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Figure 5–1. Proportion of psychiatric patients with significant psychosocial problems who do not receive psychotherapy consistent with American Psychiatric Association (APA) guideline recommendations.aData from the 1999 APA Practice Research Network Study of Psychiatric Patients and Treatments (American Psychiatric Association 1999).bData from the 1997 APA Practice Research Network Study of Psychiatric Patients and Treatments (American Psychiatric Association 1997).
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Table 5–1. Neurobiological studies of psychotherapy
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Table 5–2. Patients' feelings about the psychiatrist in integrated treatment
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Table 5–3. Patients' feelings about medication in integrated treatment

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