Conclusions

Patients with straightforward neurotic problems should not require medication treatment through the course of an analysis, but many analysts will be assessing patients with a wide range of psychopathology who may need a variety of treatment approaches. The use of standard nosologic diagnosis (DSM-IV) in addition to psychoanalytic diagnosis helps clarify the possible treatment options, and the use of appropriate medication treatment will increase the range of patients who can make use of psychoanalytic psychotherapy and psychoanalysis (Gray, 1996).

The medical psychoanalyst interested in learning to use medication is encouraged to use standard antidepressant, antianxiety, and mood-stabilizing medications with patients who are not in analysis to gain experience and confidence in prescribing. Some patients will require medication in order to engage in analysis, and the medical psychoanalyst must determine his/her level of comfort in prescribing for patients in analysis. The author recommends dealing with medication use as one would with any other piece of data in analytic treatment: Strive to clarify and address the patient's view of the use of medicine, fears and concerns about taking medication, and the transference meaning of medication. Like physicians in primary care and general psychiatry, the analyst may experience considerable relief and even gratification in seeing patients get better with medication. For the internist or general psychiatrist, the relief from symptoms means the goal has been achieved; for the analyst, the work is just beginning.

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