Academic journal article American Journal of Psychotherapy

The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness

Academic journal article American Journal of Psychotherapy

The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness

Article excerpt

ALLAN TASMAN, M.D., MICHELLE R. RIBA, M.D., AND KENNETH R. SILK, M.D.: The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness. The Guilford Press, New York, 2000, 169 pp., $30.00, ISBN 1-57230-596-7.

The magnitude of the revolution in psychiatric treatment in this country is probably still not fully appreciated-by neither the profession nor the lay public. Over the past generation, mainstream psychiatrists, who formerly provided primarily dynamic psychotherapy with perhaps some adjunctive pharmacotherapy, have increasingly become internists for psychiatric illness. In other words, a substantial and still growing number of psychiatrists now record symptoms, make a (DSM) diagnosis, and prescribe medications targeted at the diagnosed disorder, or at least at the principal symptoms that define the syndrome.

Two major developments have clearly spurred this transition: the growth in our understanding of neurobiology with the concomitant synthesis of safer and possibly more efficacious medications, and the pressure from managed care to see more patients for briefer periods of time and duration.

This trend has had unfortunate consequences for patients. Psychiatrists are increasingly inadequately trained to do technically adept psychotherapy or they give short shrift to therapy and refer their patients to nonpsychiatrist psychotherapists, thereby creating the increasingly commonplace arrangement of split treatment (with all the potential pitfalls inherent in this arrangement).

But the situation is even worse than this. Not only do psychiatrists seem to be doing less and less psychotherapy; they do not even simply communicate effectively with their patients regarding the prescribed medications, or appreciate that dynamic issues exist surrounding the prescribing and taking of medication. The Doctor-Patient Relationship in Pharmacotherapy is one of the first books to recognize and identify these problems, and to propose remedies.

The book is multiauthored, but several of the chapters represent the combined efforts of the senior authors, Drs. Allan Tasman, Michelle Riba, and Kenneth Silk. In addition to an introductory overview chapter, the topics covered include: effecting a therapeutic alliance, using the initial interview to begin the collaborative process, addressing transference and countertransference issues, managing split treatment, and dealing with particularly difficult cases. …

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