Response to Busch and Sandberg

I am grateful to Fredric Busch and Larry Sandberg for their comments and am pleased by the opportunity to engage in dialogue, however limited, with two analysts who have thought extensively about combining psychotherapy and pharmacotherapy (Busch and Sandberg 2007). As I understand them, they are in significant agreement with some of my main points, including my emphasis that under certain conditions the introduction of pharmacotherapy into an analytic process has the potential to impact the treatment in ways that might be limiting of the outcome. In other words, while pharmacotherapy is often useful in relieving symptoms and can at times even facilitate psychoanalysis, it also can interfere with psychoanalytic goals and with a psychoanalytic process. But despite their stated agreement with me, Busch and Sandberg dismiss much of what I have to say, averring that I am irrationally biased against medication. The impression I get from them is that they do not concur with the importance I attach to the analyst's attitude toward pharmacotherapy. The apparent difficulty in grasping the centrality of some patients' use of the analyst's attitudes in the construction of resistances goes to the heart of my reason for writing about it. In response and to clarify, I would like to look more closely at a few points in their thinking.

In their commentary Busch and Sandberg say that my thinking is anachronistic, a relic containing “remnants of an antimedication bias” (p. 935). They say I am reiterating an old and biased view that “the altered affective experience might [make] such [analytic] material difficult or impossible to access” (p. 940) and that I presume “that medication, by its very presence, will be problematically employed to maintain narcissistic and perverse resistances” (p. 937). But nowhere have I said these things.

My argument is explicitly and narrowly focused on some of the psychological factors—resistances—that can be involved when, as they and I agree is possible,