Psychotherapy and pharmacotherapy: the challenge of integration.

The use of psychotherapy and pharmacotherapy in combination remains a neglected area of study. In spite of evidence validating the combined treatment psychiatrists often avoid this approach. When combined treatment is employed insufficient attention may be devoted to the important interactive effects. Patients may react to the prescription of medication with a variety of transference feelings such as acceptance, rejection, manipulation and narcissistic injury. Discussion of interpersonal issues precipitated by the use of medication can improve not only the doctor-patient alliance but also the patient's symptomatic experience. The initiation or discontinuation of medications must be carried out with sufficient attention to the patient's realistic concerns and transference distortions. The neglect of a negative transference reaction aroused by the prescription of a medication can result in a resistance to treatment. Case examples and discussion in the article illustrate such phenomena. Psychiatrists need to be aware that their decision to prescribe medication may be influenced by their own unconscious conflicts surrounding the use of medication. They may prescribe or fail to prescribe motivated by their latent fantasies. Attention to the interactive effects of combined therapy is viewed as essential in order to aid patients in the dual goals of symptom alleviation and enrichment of interpersonal experience.