Integrating Meaning and Medication to Address Treatment-Resistance: Practical Psychodynamics and the Art of Pharmacotherapy

David Mintz, MD, presents the two day-workshop "Integrating Meaning and Medication to Address Treatment-Resistance: Practical Psychodynamics and the Art of Pharmacotherapy" as part of the 37th Door County Summer Institute hosted by the Medical College of Wisconsin.

The history of psychiatry is a pendulum that swings between the biological and psychosocial poles. The psychodynamic perspective that held sway for most of the 20th Century, gave way to the “Decade of the Brain,” and a privileging of biomedical perspectives. Though psychiatry benefited from an increasingly evidence-based perspective and a proliferation of safer and more tolerable treatments, psychiatric outcomes have not substantially improved. Treatment resistance remains a serious problem across psychiatric diagnoses. One likely reason is that that the systems within which mental health practitioners are working often create pressures to adopt biologically reductionistic frameworks, limiting meaningful integration of biological and psychosocial perspectives across the treatment team.

This course will review the historical and theoretical tensions between bio- and psychosocial psychiatry and will explore possibilities of integration. We will examine the evidence base connecting meaning, medications, and outcomes, will explore the dynamic meaning of medications andcommon dynamics contributing to pharmacologic treatment-resistance. We will review psychodynamic concepts relevant to the practice of psychopharmacology, and explore a model (Psychodynamic Psychopharmacology) that aims to enhance pharmacotherapy outcomes through the integration psychodynamic attitudes and skills. We will focus on techniques for fostering a patient-centered pharmacotherapeutic alliance, and will consider necessary skills for identifying and addressing psychological and interpersonal interferences with the healthy use of medications. More broadly, we will consider approaches to optimize the integration of pharmacotherapy and psychotherapy, in both combined and split treatments.