In today’s world of limited time and resources, factors have converged to limit the use of long-term psychotherapy, and to compress available spaces for prescribers and patients to explore the psychological and psychodynamic meanings of medication. A growing evidence base shows, however, that psychological factors play a significant role in the outcome of psychopharmacological treatments.
Mainstream psychiatric dialogue has narrowed to a largely biomedical perspective. The evidence bases connecting psychodynamic and psychosocial factors with medication response have tended to be sequestered outside of mainstream psychiatric journals. The neglect of these evidence bases and the adoption of a largely non-integrative model is likely a significant source of the current epidemic in treatment resistance.
There are a number of psychological and social factors that can interfere with the healthy use of medications, including family dynamics, patient’s interpersonal styles and attitudes towards the use of medication and the quality of the doctor-patient relationship and whether the patient trusts the doctor’s understanding of the patient’s needs and potential resistances.
Patients often come into treatment at Riggs with a long history of medication use, often beginning in adolescence or earlier. The relationships patients have with their medications are often important, complex, and conflicted. An evaluation of the patient, especially in the context of treatment resistance, must consider not only objective-descriptive factors, such as correct diagnosis and application of evidence-based treatments, but also an assessment of psychosocial contributors to treatment resistance. The beginning of the work with that patient is to negotiate a realistically complex understanding of the role of medications, in a way that supports the patient’s psychological resources in the service of recovery.
Dr. Mintz talks about the doctor-patient relationship and medication:
InContext  - Workshop 1: Psychodynamic Psychopharmacology: Applying Practical Psychodynamics to Improve Pharmacologic Outcomes
David Mintz, M.D. , will review the evidence which unites bio- with psychosocial in relation to psychopharmacology, and will elucidate a model of integrated treatment that can address psychosocial resistances to healthy use of medications, promoting improved outcomes in treatment resistant populations.