Psychotherapy and Medication: The Challenge of Integration by Frederic N. Busch and Larry S. Sandberg  The Analytic Press, New York, NY, 2007;  177 pp; $35.96

Psychiatrists have been using anti-psychotic, anti-depressive, and anxiolitic medication to treat the more intractable symptoms of their patients since the 1950s. Until recently, psychoanalysts have been trained to avoid medications during psychoanalytic treatment. In the past, the indications for psychoanalysis were narrower: high functioning neurotics with intact ego functioning were considered ideal patients for psychodynamic treatment. During the 1970s, psychoanalytic innovators such as Kernberg began recommending treating more impaired patients with modified psychoanalytic techniques. This change led to redefining the scope of psychoanalysis so that patients with disorders that included deficits, traumas and developmental impairments were treated. Modifications in technique were introduced but the treatment was still called psychoanalysis. Meanwhile, more efficacious medications to treat depression, anxiety and psychosis became available and were widely prescribed. A scientific rationale for their use was put forth by numerous neurophysiological studies.

The new medications and the widening scope of psychoanalysis have led to an increasing number of psychoanalytic patients treated with combined therapy (medication and psychoanalysis). Although the empirical use of combined treatment has been widespread, it has not yet been sufficiently integrated into psychoanalytic clinical theory. This book attempts to answer many of the questions generated by combining the two treatments. Bush and Sandberg, the two authors, are affiliated with the Department of Psychiatry at Weill Cornell Medical School and the Columbia University Center for Training and Research. The identify themselves as both psychoanalysts and psychopharmacologists. In describing their theories and clinical work, they put forth a model for role integration.

Let us imagine different groups of prospective readers that do not usually use combined treatment. In one group are psychoanalysts who believe that, as