Presenter: |
Jeffrey Deitz, MD |
Chair: |
Jaga Nath S. Glassman, MD |
Self Psychology Page | 21th Conference
Program
Summary
Dreams about medical interventions, including prescriptions, are not new, but their psychodynamic understanding can lead to insight into the mind of the dreaming patient and his experience of the intervention. This is increasingly important in today working with depressed, bipolar, and/or anxious patients who use or might benefit from mood stabilizing, anxiolytic, or antidepressant medication (or some combination thereof), but who resist that recommendation from their psychotherapists, psychiatrists, or other medical practitioners. Viewed from an intersubjective perspective, we can investigate dimensions of selfobject transference as they influence the prescriber-prescribee relationship, and allow dreams about medication to guide our understanding of the patient's experience.
Vignettes of varying diagnostic categories of patients and familiar forms of medication resistance (in one case the patient was actually asking for more of the medication), will be presented. Using a self psychological framework, it becomes possible to understand that the reluctance to cooperate unconditionally in the psychopharmacologic endeavor is often only another of the understandable manifestations of an already stressed and sometimes fragmented self trying to preserve a kind of narcissistic equilibrium in the face of yet another blow to the self.
In some circles, the term medication "compliance" is used, but here the term "resistance" is preferred, because this phenomenon can be explored psychodynamically, like any other resistance to therapy that we would expect to encounter in the clinical setting. Just as patients rarely, if ever, accept/swallow interpretations or recommendations in toto, it is just as rare that they ingest prescriptions exactly as prescribed, at the recommended times, without experimenting-in my experience this is the norm: attempts are made to individualize and optimize medication response.
At the conclusion of the presentation, the participant will be able to look at the prescription of medication for patients with anxiety and/or mood disorders from the same perspective that the participant might assess other interventions that are made in the course of ongoing self psychologically informed therapy. Issues such as medication resistance can then be addressable through understanding the relevant selfobject needs of patients and worked with in therapy. The goal of medication therapy is to stabilize the patient's mood and level of functioning so that more stable (selfobject) transferences can emerge and be maintained in treatment, the understanding and ruptures thereof leading to psychic growth.