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THIS PAPER CONSIDERS THE USE of pharmacotherapy in treatment as a special case of the general proposition that current psychoanalytic practice is characterized by movement away from the "classical" toward a more flexible psychoanalytic therapy. This flexibility consists of modifications in analytic procedure per se; and of adding to analytic procedures varying non-analytic modalities, such as behavioral methods and drug therapy. Short term dynamic psychotherapy is increasingly important as a modified psychoanalytic procedure.
None of these modifications is new. It has been pointed out often, for example, by Judd Marmor (1981), that Freud and many of the early Freudians carried out short term analyses. Effective psychotropic medication was not available in the early years, but it is well known that Freud believed that biological, constitutional factors were an essential aspect of the person; and anticipated the future discoveries of chemical substances which would alter these biological factors. For example, in his "Outline" (1940), he stated clearly:
The future may teach us how to exercise a direct influence, by means of particular chemical substances, upon the amounts of energy and their distribution in the apparatus of the mind. It may be that there are other undreamed-of possibilities of therapy. But for the moment we have nothing better at our disposal than the technique of psychoanalysis, and for that reason, in spite of its limitations, it is not to be despised (p. 182).
Since the advent of effective drugs in the 1950's pharmacotherapy has been an important ingredient of the treatment of schizophrenia, bipolar affective disorders, and severe unipolar depressions. Use