Psychopharmacotherapy and Psychotherapy: Treating Target Symptoms and Learning

When a portion of one's self system lacks necessary creativity and adaptability, one loses freedom of will; that is one loses freedom of choice about what one does, but rather finds oneself repeating a preordained pattern. The air is not simply to remove symptoms but by reworking the self system's information processing mode, to restore the patient's creative capacity and freedom of choice.

I was eagerly involved in my psychiatric residency training in the early 1960s, a time of great excitement. In San Francisco, my supervisors were all analytic candidates or senior analysts. Fritz Perls and Eric Berne, as well as Bateson and Jackson with the “double bind” theory of schizophrenia, were in vogue. Sidney Tarachow's book on psychotherapy was our guide.

Although the neuroleptics, tricyclics, and monoamine oxidase inhibitors had been discovered, they were just beginning to be used with enthusiasm on one acute treatment unit. Residents were not routinely rotated on this unit in our hospital. This was a relief, since it was rumored to be headed up by a mean-spirited psychiatrist who had more the ill-tempered manner of a surgeon than that of a psychodynamic psychiatrist. There was little to no clinical supervision in the use of neuroleptic or antidepressant medications, and one got the impression that they were considered sedatives with a non specific effect of quieting the patient while psychotherapy commenced. I could not get much specific advice from my supervisors on when to give medication, or the principles of choosing a specific agent or adjusting the dose, much less on how to combine them with psychotherapy. I have outstanding memory from that time of being told by a supervisor (nameless and faceless in my memory, of course) that a patient's diagnosis did not matter, it was only the individual psychodynamics that counted. This was very upsetting to me since I had just finished a rotating internship and felt very commit