Medication Consultation and Split Treatment During Psychotherapy

In split treatment a patient simultaneously sees both a psychotherapist and a pharmacotherapist. Research indicates that medication and psychotherapy have additive value when used together in the treatment of depression and probably in other disorders as well. However, little is known about the presumably common technique of separate therapists administering these treatments. Complex interpersonal issues arise, reflecting both ideological and transferential attitudes toward medication as well as the intricacies of triangular relationships. Establishing a three-way therapeutic alliance, awareness of competitive countertransference feelings, and recognition of covert issues other than medication in the request for consultation are examples of areas where special attention can help the treatment succeed.

The use of medication during psychotherapy raises interesting issues. I will discuss one way in which medication may be introduced, by consultation and subsequent split treatment. In split treatment a patient essentially has two ongoing therapists: a psychotherapist and a pharmacotherapist. (The latter term is more descriptive than psychopharmacologist). This differs from combined treatment, where one psychiatrist administers both psychotherapy and medication. Psychotherapists seem increasingly willing to recommend concurrent medication for certain patients. One might guess that their decision to employ split or combined treatment depends mainly on their training. This is obvious with non-physicians; Beitman et al. (1984) have estimated that up to 210,000 patients per month are seen in split treatment between psychiatrists