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The burgeoning of the psychiatric pharmacopoeia presents us with a new set of parameters to deal with in treatment. Such variables as frequency of sessions, therapeutic goals, fees, the nature of the therapeutic relationship, the model of disease or dysfunction, are now both joined and effected by questions regarding prescribing. Many of these questions have been around for a while. However, until recently they were applied to a smaller population of more impaired patients, those who tended to be treated in hospital-based practices.
Now, with the widespread use of psychotropic agents and the promise of more agents and still wider use, comes a greater need to understand not only their direct neurophysiological effects but also the various psychodynamic and systems interactions involved in their use, particularly in the context of psychotherapy. From our current vantage point it seems very unlikely that either psychotherapy or psychopharmacology will replace each other. The strongest trends indicate more use of these two together in so-called combined therapy (Donovan & Roose, 1995; Michels, 1995).
Part of the luggage we bring along with our prescription pads, therefore, is the necessity to integrate our models of treatment. Factors in patients which effect medication use and response contribute to our understanding of what Gutheil (1982) called “The Psychology of Psychopharmacology.” Gutheil's paper, one of the best on this subject about which surprisingly little has been written, focuses on the physician's side of the therapeutic equation as well as the patient's. I also recommend a 1987 paper by Howard E. Book. It is the physician's and therapist's contributions to the psychodynamics of prescribing on which I will focus in this article.
In this discussion I'm not trying to emphasize difficulties created by countertransference issues, but rather to encourage openness in recognizing some of our motives and influences in order to be more effective.