Frontline: Psychotherapy and Pharmacotherapy

Editor's Note: We are pleased to include articles presented at the Joint Symposium of the American Psychiatric Association and the American Academy of Psychoanalysis and Dynamic Psychiatry in Toronto, May 2006. The organizer and Chair of the Symposium, entitled, “The Meanings of Medication: Issues of Patients' Compliance with Psychotropic Drugs,” was Ann Ruth Turkel, M.D. This discussion and the articles that follow have been modified more or less for purposes of publication. At the Symposium, the discussion followed the presentations; here, the discussion precedes and introduces them.

There is no better way to start a debate on the combination of pharmacotherapy and psychotherapy than by inquiring on issues such as the dynamics of compliance with drug prescription and the meanings of medication. Human beings are complex creatures and, as all the authors of the articles that follow in this Symposium clearly agree, pure “medication management” is not enough to restore their holistic equilibrium. Impairments in optimal auto regulation require a complex intervention at all levels of functioning, from the molecular to the meaningful. However, the attempts to reduce one or both therapeutic approaches—biologic and psychologic—to mere “techniques,” that can be applied by independent “experts,” is one of the biggest mistakes of modern psychiatry. The complex approach to a complex being cannot be achieved by fragmentation, but by the construction of a therapeutic dyad. Even if we invoke the team approach, this is by no means free of limitations. In my experience, two therapists working with the same patient are always at risk of perverting cooperation into competition or interference