Psychoanalysis.  2021 Oct;32(4):155-160. 10.18529/psychoanal.2021.32.4.155.

Psychodynamics of Medication Adherence in the Treatment of Psychiatric Patients

• Song MS
• Jung SB

• KMID: 2521510
• DOI: http://doi.org/10.18529/psychoanal.2021.32.4.155

Abstract

Medication adherence is instrumental for better treatment outcomes. However, many patients—especially psychiatric patients— do not stick to their prescription. In this study, we analyzed the factors associated with treatment adherence and improvement using psychodynamic and psychotherapeutic techniques. The psychodynamic formulation in psychopharmacology can be used to improve medication adherence in most treatment settings. The components of the formulation include psychodynamic signifi-cance of medication and symptoms, transference, countertransference, and patient’s attachment style. Even though the psychody-namic significance of medication varies with the patient, a few common features include medication as transitional object and self object. Both transference to the medication and the therapist involve adherence. Counter-transference can also alter the thera-pist’s prescriptions. The psychodynamics of illness and symptoms may hinder the patient from taking medication. For example, the secondary gain of illness and patient’s denial of mental illness complicate the treatment. The attachment style of patients can affect adherence as well. The patient with avoidant attachment style is less likely to follow the prescription. The therapist should deal with negative transferences and counter-transferences, which might hamper treatment. A warm and collaborative approach can help patients with an avoidant attachment style to accept pharmacologic treatment. In conclusion, the capacity of the therapist to assess the therapeutic relationship, determine the psychodynamic significance of the medication, and employ relevant therapeutic in-terventions is vital for improved medication adherence.

Keyword

Medication adherence; Psychopharmacology; Psychodynamic; Psychotherapy; Attachment.