Goldhamer P M
Can J Psychiatry. 1983 Apr;28(3):173-7. doi: 10.1177/070674378302800303.
The use of psychotherapy and pharmacotherapy in combination remains a neglected area of study. In spite of evidence validating the combined treatment psychiatrists often avoid this approach. When combined treatment is employed insufficient attention may be devoted to the important interactive effects. Patients may react to the prescription of medication with a variety of transference feelings such as acceptance, rejection, manipulation and narcissistic injury. Discussion of interpersonal issues precipitated by the use of medication can improve not only the doctor-patient alliance but also the patient's symptomatic experience. The initiation or discontinuation of medications must be carried out with sufficient attention to the patient's realistic concerns and transference distortions. The neglect of a negative transference reaction aroused by the prescription of a medication can result in a resistance to treatment. Case examples and discussion in the article illustrate such phenomena. Psychiatrists need to be aware that their decision to prescribe medication may be influenced by their own unconscious conflicts surrounding the use of medication. They may prescribe or fail to prescribe motivated by their latent fantasies. Attention to the interactive effects of combined therapy is viewed as essential in order to aid patients in the dual goals of symptom alleviation and enrichment of interpersonal experience.
心理治疗与药物治疗联合使用仍是一个被忽视的研究领域。尽管有证据证实联合治疗有效，但精神科医生常常避免采用这种方法。在采用联合治疗时，可能没有充分关注重要的交互作用。患者对药物处方可能会产生各种移情感受，如接受、拒绝、操控和自恋性伤害。讨论药物使用引发的人际问题不仅可以改善医患联盟，还能改善患者的症状体验。药物的起始或停用必须充分关注患者现实中的担忧和移情扭曲。忽视药物处方引发的负性移情反应可能导致治疗抵抗。文章中的案例及讨论阐述了此类现象。精神科医生需要意识到，他们开处方的决定可能受到自身围绕药物使用的无意识冲突的影响。他们可能受潜在幻想驱使而开处方或不开处方。为帮助患者实现缓解症状和丰富人际体验这两个双重目标，关注联合治疗的交互作用被视为至关重要。
