Dynamic psychopharmacology and treatment adherence.

Abstract The practice patterns of US psychiatrists have changed over the last two decades, favoring brief clinical encounters and a primary emphasis on pharmacologic care. The main focus of this paper is to illustrate the relevance of psychodynamic principles to prescribing practices. Psychodynamic aspects of pharmacotherapy will be described, including the dynamics of treatment adherence and nonadherence, medication selection, discontinuation, as well as aspects of transference and countertransference relevant to the practice of psychopharmacology. The dynamics of medication choice, underprescribing, and overprescribing will be reviewed to highlight the importance of psychodynamically informed psychopharmacology in the care of psychiatric patients. Special emphasis will be given to the contributions of attachment theorists to our understanding of treatment adherence. Psychoanalysts and dynamic psychiatrists are in a unique position to enhance psychopharmacologic case management by exploring the unconscious determinants of behavior.