Psychotropic agents in psychotherapy—the subjective meaning of medication in different levels of self/object differentiation (neurosis, borderline, psychosis)

Abstract

Psychotropic agents and psychotherapy are often used nowadays in combination. This paper deals with the subjective meaning that psychotropic agents may have in an individual psychotherapy case. It is shown that on the neurotic level, psychotropic agents are often correlated with unconscious (transference) wishes and anxieties, which are expressed e.g., in the desire for psychopharmacotherapy. On the borderline level, psychotropic agents generally create ‘proto-symbols’ (transitional objects, fetishes); they are frequently used to cope with strong anxieties. On the psychotic level, psychotropic agents may be equated with internal objects both good and evil, and may trigger both fears of poisoning, and expectations of their omnipotent healing power. But psychotropic agents may also have a subjective meaning for the therapist; this is demonstrated in connection with countertransference. The paper concludes with references to possibilities and limitations when dealing with the subjective meanings of a psychotropic agent in an individual psychotherapy case.