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During supervision, a psychiatry resident casually mentioned her response to a depressed patient's request for a change of antidepressant: she prescribed a new one. Should this have been the cause for supervisory intervention?
This is a difficult question. The prescription of antidepressant medication is routine and normative in current mental health practices. Psychiatrists regularly prescribe SSRIs for depressed and anxious patients, and psychoanalysts routinely prescribe for depressed analysands or refer them for medication. Medication is a first-line treatment for depression and anxiety, recommended by psychiatric textbooks and by the American Psychiatric Association (2002).
In this climate, it is a challenge for a psychoanalytic supervisor and a trainee involved in treating a patient dynamically to consider possible antitherapeutic elements of complying with the patient's request. To look at the prescription of medication as a countertransference compromise formation seems almost anachronistic (Blackman 2003). Nevertheless, the following supervisory sessions with Dr. X, a psychiatry resident at Eastern Virginia Medical School, led to some possibly instructive discoveries regarding her patient's request and her response to it.
Mr. A, a 37-year-old, married man, entered treatment for depression due to confusion over his infidelity during his marriage.