This paper presents a framework for understanding the psychodynamic issues pertaining to psychopharmacology. It examines the treatment situation from three perspectives: the self-in-relation-to-others, the patient-prescriber relationship, and cultural attitudes. It discusses psychodynamic factors involved in clinical improvement and deterioration. The relevance of these issues is discussed and contrasted with the biomedical model of mental illness. It concludes by advocating the mindfulness of psychodynamic factors and the maintenance of dialectics in clinical practice.