The analyst's attitude toward pharmacotherapy.
The increased acceptance of medication in psychoanalysis has occurred with too little consideration of possible complications. The potentially adverse psychological effects and disintegrative aspects of this important technical modification require further examination. While the use of phenomenologically defined diagnostic criteria provides valuable guidance to the clinician, the decision to include pharmacotherapy in a psychoanalysis must be understood also as a transference-countertransference enactment. The analyst's attitude toward pharmacotherapy is an essential element in some defensive and gratifying enactments, resistances that can interfere with psychoanalytic processes. Clinical material is presented illustrating narcissistic and perverse resistances that might be facilitated by analysts' attitudes toward pharmacotherapy, attitudes often tacitly communicated in decisions to use combined treatment.
Purcell
Stephen D
SD
San Francisco Center for Psychoanalysis, Psychoanalytic Institute of Northern California, San Francisco, CA 94115, USA. purcellsd@comcast.net
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy; D003142:Communication; D003379:Countertransference; D003469:Culture; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009289:Narcissism; D010817:Physician-Patient Relations; D011575:Psychoanalytic Therapy / Q000379:methods*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D014167:Transference, Psychology
D018687:Antidepressive Agents, Second-Generation; D011619:Psychotropic Drugs; D005473:Fluoxetine