In our work as psychodynamic psychotherapists, we shift between different models of etiology and therapeutic action in assessing and treating our patients. One example of this is our need to think about whether medication or psychotherapy will best address a patient's problems and symptoms at any point in time.
The prescribing and taking of medication has psychological meaning for both patient and therapist.
When a patient in psychodynamic psychotherapy is also taking psychotropic medication, sometimes the therapist will be the prescriber and sometimes there will be a separate pharmacologist. Each of these situations has different clinical implications.
The patients who come to us for treatment generally will not arrive asking specifically for medication versus psychotherapy. They will come complaining of a problem (or set of problems), of symptoms, and of difficulties in their lives. They may already be taking medication for these problems or symptoms, or may have taken medication in the past. Some patients will have strong opinions about medication, while others may not have given it much thought.
As psychodynamic psychotherapists, our listening is empathic and non-judgmental and involves asking open-ended questions, looking for hidden meaning, and helping patients to feel safe. However, we have to simultaneously listen as mental health professionals, which involves listening for medical and psychiatric symptoms and syndromes, side effects, and therapeutic effects. We also have to be able to shift gears in order to be more active when needed, to take the lead, to ask specific questions, and to give recommendations or advice about medication [26].
Using psychodynamic and phenomenological models simultaneously
The DSM takes a descriptive or phenomenological approach to psychiatric disorders, without reference to etiology. As psychodynamic psychotherapists, we have to learn to use both psychodynamic and phenomenological models of etiology and treatment simultaneously. Here's an example of how a psychodynamic psychotherapist might do this: