CS07-02 - Combining Psychotherapy and Drug Treatment: Does it Change the Process of Psychotherapy

Abstract

After many decades of strenous relations between psychotherapy and pharmacotherapy - especially from psychoanalytic quarters -, Ostow (1962) was one of the first and foremost clinicians to develop a constructive and synergistic relationship between psychoanalysis and psychopharmacology. In his 1962 book “Drugs in Psychoanalysis and Psychotherapy” he outlined his position that drugs alone subdued the symptoms but did not treat the underlying disturbance of mental illness. Recently the issue of combining those two approaches is no longer controversial; the focus of attention has moved to questions of shared responsability between the drug-providing psychiatrist and the psychotherapist. The term „psychodynamic pharmacotherapy” has become fashionable.

From the standpoint of a researcher in psychotherapy the issue is embedded in the well established fact that the portion of outcome variance explained by technique is fairly small. Larger portions are explained by the capacity of patients to use psychotherapy, and by the capacity of therapists to provide psychotherapy (Lambert & Barley 2002). Combining the two approaches has become a matter of individualized strategy. Further research is needed to identify those clinical situations in which psychotherapy is especially helpful, f.e. to overcome resistance against medication. Moreover, as greater insights are gained into the brain mechanisms responsible for therapeutic changes, more specifically targeted combined approaches can be developed (Gabbard 2007).