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This article addresses the current role of the medical psychoanalyst as the deliverer of psychiatric services within the context of his/her specialty, psychiatry. As a psychiatrist trained in psychodynamic concepts the medical psychoanalyst finds him or herself in the ideal position of using a verbal therapeutic modality based on psychodynamic principles, sometimes in conjunction with a psychopharmacological regimen, for the treatment of diagnostic entities of functional or organic origin as defined by the current Diagnostic and Statistical Manual (fourth edition; DSM-IV) of the American Psychiatric Association (APA; 1994).
The volume, cost, and patterns of usage of psychotherapy and its effectiveness as a therapeutic modality in a series of psychiatric nosological states and in positively altering the outcome of other medical illness has been amply documented (Olfson and Pincus, 1994a, 1994b). The APA, recognizing the importance of the role of psychotherapy in the treatment of mental disorders, published a position statement on medical psychotherapy in November 1995 (American Psychiatric Association, 1995). Advances in the study of the functioning brain show how structured verbal interventions aimed at both the understanding of symptoms and of the individual who suffers such symptoms affect interneuronal connections (Schwartz et al., 1996). During the past 40 years and since the appearance of the first neuroleptic, psychopharmacology has advanced to the point that psychiatrists are facing the same predicament as the rest of medicine; that is, a variety of choices so great that they can be overwhelming to practitioners and patients. This reality is complicated further by the current and recent trend of advertising prescription drugs in the mass media, by the existence of popular books addressing the combination of medication and other psychotherapeutic methods, and by the frequent presence of articles in the mass media addressing the efficacy of a