What is it about?
Taking (and prescribing) medications is complicated. Medications can carry lots of different meanings, many of which are not particularly positive. Such negative meanings and associations are often not fully conscious, and so work in the background, undermining the effectiveness of treatment and causing a range of other problems, such as increased side effects (nocebo responses). The likelihood of these negative effects increases with the patient's history of early adversity and experiences of powerlessness. This book helps to explore these factors empathically and to address psychological sources of treatment-resistance in psychiatry.
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Why is it important?
Inadequate response to psychiatric treatment is a significant problem that is extremely costly, both financially, and, more importantly, in its human toll. An illness-centered, narrowly biomedical approach to this problem often misses the true sources of treatment resistance. This book can help clinicians to formulate non-response to psychiatric medications in patient-centered terms and offers psychodynamically-informed perspectives and techniques to help address treatment-resistance at it roots, using the patient's developmental aims and the therapeutic alliance as a fulcrum.
Perspectives
Early on in my practice at the Austen Riggs specializing in patients who had already failed to benefit from a range of of psychiatric treatments, it became quite apparent to me that, in many of these situations, aspects of my patients psychologies were a big part of why my patients could not derive significant benefit from pharmacotherapy. Some held such negative (if unconscious) feelings about medications that everything caused intolerable side-effects. Others had had such negative experiences with caregivers (parents or clinicians) that their distrust undermined the treatment. Others had found the hidden benefits of being ill, and so had become ambivalent about getting better. Still others became attached in unhealthy ways to medications in ways that undermined their agency and personal growth. I realized that the usual ways of addressing treatment-resistance (new medications, new diagnoses) would often do little to help my patients. Rather, when the problem derived from the level of meaning, I had to learn how to address the problem at that level. This book came out of that effort.
David Mintz
Austen Riggs Center
Read the Original
This page is a summary of: Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient, February 2022, American Psychiatric Association,
DOI: 10.1176/appi.books.9781615379064.
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