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Psychotherapy, Psychopharmacotherapy, and Neuromodulation

  • Peter Hartwich
  • Heinz Boeker
Chapter

Abstract

Whether you want it or not, when psychopharmaceuticals are given, there is always involved a psychodynamic component. Thus, the prescription of the drug is embedded in the relationship of the two dissimilar partners: patient and doctor. In the case of many psychoses, the use of psychopharmaceuticals can help to build up a viable therapeutic relationship and can be the prerequisite for psychotherapy. The bottom-up effects by means of psychopharmacotherapy can be completed with the top-down effects which are mediated by means of psychotherapy. This underlines that psychotherapy modulates biological processes indirectly (by activating psychogenetic material). On the other hand, psychopharmaceuticals can change biological reaction patterns directly. Thus psychopharmacotherapy and psychotherapy are to be seen as different—but additional—components of a multimodal treatment concept.

Furthermore, different modalities of targeted neuromodulation (e.g., vagus nerve stimulation (VNS), deep brain stimulation (DBS)) are being actively researched as putative treatment options for treatment-resistant forms of depression.

A special challenge concerns the adequate weighting of the single component in different disorders regarding the individual situation of each single patient.

We show how this therapeutic approach is experienced in depressive patients, schizophrenics and other psychiatric disorders. Important is that the therapist reflects his inner position and represents a clear attitude in the interaction of psychodynamics and psychopharmaceuticals; we try to explain which factors are effective and how the role of relatives is in relation to the reliable intake of medication. In difficult patients, who omit their medication in a critical situation, it is important that a treatment partnership is established with a family member. The example of group psychotherapy serves to show that “experts among themselves” have a great influence on the willingness to take medication in a neuropsychodynamic context.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Psychotherapy, PsychosomaticsGeneral Hospital of Frankfurt am Main, Teaching Hospital University FrankfurtFrankfurtGermany
  2. 2.Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric University Hospital Zurich, University of ZurichZurichSwitzerland

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