Psychodynamic Psychopharmacology Strategic Initiative
Psychodynamic psychopharmacology is an approach to pharmacotherapy that explicitly acknowledges the central role of meaning and interpersonal factors in promoting good treatment outcomes. It is informed both by a psychodynamic perspective and by an evidence base that suggests that psychosocial aspects of medications are often more potent than the putative active ingredients of those medications. The psychodynamic perspective emphasizes that meaning can have profound influences on the effects of any intervention, that these meanings are often obscure and require time and attention to illuminate, that patients’ desires from treatment are complex and multilayered, that the doctor-patient relationship can be a powerful tool for healing, and that the doctor, as much as the patient, is vulnerable to succumbing to irrationality in the context of the patients’ distress. The evidence base that is incorporated into the treatment model and treatment recommendations emphasizes, among other things, the role of the placebo (and nocebo) effect on treatment outcomes; the role of the patients’ desires, expectations, and ambivalence on treatment outcomes; and the potency of the therapeutic alliance, including the role of active engagement of patient preferences in promoting good treatment outcomes and a recognition that patients who experience treatment as disempowering are less likely to benefit from treatment.
The initiative seeks to:
- Operationalize the technical recommendations of psychodynamic psychopharmacology into measurable prescribing behaviors in the form of a treatment manual that will both guide a research program and offer guidance for the practicing clinician. The Manual of Psychodynamic Psychopharmacology is currently under contract for publication with American Psychiatric Association Publishing.
- Test the usability of the manual with clinicians to ensure that it offers recommendations that prescribers can follow without significant difficulty.
- Conduct randomized, controlled trials to determine that the model will work for patients who have failed to benefit from a number of medication trials, thus adding to the evidence base for the importance of psychosocial factors in effective pharmacotherapy, and for the utility of applied psychodynamics in pharmacotherapy.
David Mintz, MD, Team Leader, Staff Psychiatrist, and Initiative Leader