Combined pharmacotherapy and psychotherapy.

Abstract

This paper summarizes controlled studies on combined pharmacotherapy (chronic dosage) and psychotherapy in the literature since 1950. Studies purportedly or actually comparing the effects of combined treatment with the effects of either treatment alone are included. Major tranquilizers, minor tranquilizers, group psychotherapy, individual psychotherapy, schizophrenic patients and psychoneurotic patients are relatively well represented, along with single studies dealing with insulin, antidepressants and depressed patients. From a practical point of view, these studies consistently suggest that combined treatment is superior to psychotherapy alone, but not to pharmacotherapy alone. From a theoretical point of view, these studies suggest that the effect of two treatment interventions combined is the same as the effect of the more effective intervention alone. Unfortunately, this point remains highly tentative because of limitations in the design and execution of the available studies. The effect of the psychotherapy offered constitutes a major question in most of the studies reviewed. They suggest that the role of psychotherapy in combined treatment may be clarified in part by including assessments of the effects of psychotherapy alone and pharmacotherapy alone in the designs of future studies. Studies of psychotherapy suggest that the role of psychotherapy in combined treatment may be further clarified by providing contrasting “dosages” of psychotherapy in terms of certain crucial indicators: the therapist's level of experience; the levels of accurate empathy, nonpossessive warmth and genuineness he offers his patients; his score on the Whitehorn-Betz A-B Scale; and the extent to which his interests on the Strong Vocational Interest Blank correspond to those of a reference group of successful psychiatrists.