A psychodynamic approach to treatment resistance

Abstract

Despite the growth of neurobiologic research in psychiatry, the fundamental clinical problems of psychiatry remain unresolved. “Treatment resistance” has become an increasingly recognized problem. Meanwhile, financial and academic support for psychodynamic concepts has decreased, with a troubling bias against psychodynamic ideas. Nevertheless, psychodynamic concepts and psychodynamic therapy (PDT) offer opportunities for novel, effective approaches to treatment resistance. Conceptual errors in mainstream psychiatry include ignoring the meaning of psychiatric symptoms, assuming that patients are best described by single diagnoses, assuming that mental illness is always caused by a specific biological pathology that can be addressed by a biological treatment, neglecting the effects of the psychosocial context on treatment, and failing to attend to the treatment alliance. This chapter reviews literature describing psychodynamic approaches to treatment resistance and demonstrating the relevance of psychodynamic concepts and the effectiveness of psychodynamic therapies.