The Austen Riggs Center has been a leader in the field of psychiatry when it comes to integrating a psychodynamic approach into traditional medication management for individuals struggling with psychiatric illness.
In fact, our Director of Psychiatric Education David Mintz, MD, has authored a first-of-its-kind treatment manual entitled Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient. In the book, Mintz explores some of the reasons that treatment-resistance is so common in psychiatric treatment, shows how a psychodynamic perspective can be joined with the evidence base that connects meaning and medication, illuminates common dynamics that contribute to pharmacologic treatment-resistance, and offers technical recommendations for addressing pharmacologic treatment resistance.
Our research, and the research of others, suggests that psychosocial aspects of medications are often more powerful than the active ingredients of those medications. Our psychodynamic perspective emphasizes that:
Meaning can have profound influences on the effects of any intervention, including medications
These meanings are often obscure and require time and attention to illuminate
Patients’ desires from treatment are complex and multilayered
The doctor-patient relationship can be a powerful tool for healing, even in pharmacotherapy
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 our psychodynamic psychopharmacology treatment model and treatment recommendations emphasizes, among other things, the role of:
Placebo (and "nocebo" or negative placebo) effects on treatment outcomes
Patients’ desires, expectations, and ambivalence about treatment outcomes
The power 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