정신역동과 약물순응도

• Published in: 정신분석, 32(4) pp. 155 - 160
• Main Authors: 송명선, 정수봉
• Format: Journal Article
• Language: Korean
• Published: 한국정신분석학회 01.10.2021
• Subjects: 정신과학
• ISSN: 1226-7503; 2383-7624
• DOI: 10.18529/psychoanal.2021.32.4.155

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 significance of medication and symptoms, transference, countertransference, and patient’s attachment style. Even though the psychodynamic 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 therapist’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 interventions is vital for improved medication adherence. KCI Citation Count: 0