Exporting Thinking About Meaning and Medication



David Flynn, MD, 2015 PsychSign and APA Presenterby Aaron Beatty

As a fourth-year medical student at the University of Massachusetts Medical School, current Riggs Director of Psychiatric Education and Associate Director of Admissions David F. Flynn, MD, spent two months at Riggs in its Elective in Psychodynamic Psychiatry program, which he says “shaped my residency training and had a profound impact on how I thought about patients.” Recently, Dr. Flynn was invited to give a series of lectures to third- and fourth-year residents at his alma mater on the “Intersection of Psychotherapy and Medication,” a topic that is central in his work and about which he has researched and written. 

The first lecture focused on the evidence for the role of meaning in medications. The purpose of the lecture, as Dr. Flynn explains, is “to help residents who are learning the biochemical dimensions of psychopharmacology pay attention to the way individual characteristics and therapeutic alliance can affect outcome. There are factors that have much more to do with the person than the disease.” 

According to Flynn, this way of thinking is not broadly taught in residency programs; introducing it in this medium gives residents another way of thinking about why someone might or might not respond to medication. “We get so narrowly focused on receptors . . . that we can’t step back and take the broadest view possible of the person and see how that might affect things,” remarks Flynn. 

The second lecture focused more on specific clinical cases (some brought by residents) and the application of six technical principles spelled out in a 2012 paper Dr. Flynn co-authored with Riggs team leader and psychiatrist David Mintz, MD, titled “How (Not What) to Prescribe: Nonpharmacologic Aspects of Psychopharmacology.” 

The six technical principles discussed in the lecture are:

  1. Avoid mind-body split
  2. Know who the patient is
  3. Attend to ambivalence about loss of symptoms 
  4. Cultivate the therapeutic alliance
  5. Attend to countertherapeutic uses of medications 
  6. Identify, contain and use countertransference 

This lecture provided an opportunity for Dr. Flynn to talk to residents about things they see in their clinic and how this approach to thinking about medication and prescribing might be helpful or useful in their practice.  

While the topics Dr. Flynn covered in these lectures are descriptive of the ways psychiatrists approach medication management at Riggs, he is quick to point out, “there’s nothing magical about this setting [Riggs] that makes it possible to work in this way here and not in other places. You can actually take these ideas and principles and apply them to any patient you are working with in any setting and use them in a way that can make a difference.” 

Dr. Flynn acknowledges, “There is constant tension between the biological and psychological and psychosocial,” but goes on to say, “at Riggs, we try to think about all of those things in a more comprehensive way, and to be able to share that, I think, provides a possibility for patients to be fully understood in terms of their struggles, which ultimately improves patient care.” 

Speaking specifically about the residents he had an opportunity to speak with during his two lectures, Dr. Flynn says “as they’re learning this basic set of skills, you’re adding this in as something to think about. To be able to, even briefly, talk with them about another way they can think about their work with patients feels tremendously rewarding.” 

Learn more about how Riggs approaches medication management: