Book Review
Psychopharmacology
Doctor–Patient Relationship in Pharmacotherapy. Allan Tasman, Michelle B Riba, Kenneth R Silk, editors. New York: The Guilford Press; 2000. 182 p. US$30.00.
Reviewer
rating*: Excellent
Review by: Ronald A Remick, MD, FRCPC
Vancouver, British Columbia
I have often commented to my students that, contrary to popular beliefs within our specialty, psychotherapeutic skills may need to be at their peak when we initiate and maintain psychopharmacological interventions with our patients. In my opinion, it is remarkable that compliance occurs at all when we explain to a patient that we want to treat him or her with a medication that could cause weight gain, sedation, or sexual dysfunction; that the treatment will certainly not result in any noticeable improvement in acute distressing symptoms for at least 3 to 4 weeks; and that the probability of said response is a little less than 2 out of 3!
Thus it is refreshing to review this gem of a monograph that deals with the “art” of psychopharmacotherapy. The authors correctly note that, all too often, the psychiatrist’s role in mental health centres and chronic care facilities has become that of a “medication manager,” and increasingly cost-conscious health care providers are divesting psychiatrists of their role in psychosocial inter- ventions, which are now in the realm of less expensive nonpsychiatric therapists. The reality of our American colleagues is increasingly upon us, and we need to apply our psychotherapeutic skills to the pharmacologic interventions we provide.
The book is a brief monograph of 170 pages and comprises the following 7 chapters: 1) “Overview and Framework,” 2) “Forming an Effective Therapeutic Alliance,” 3) “Using the Interview to Establish Collaboration,” 4) “Enhancing Adherence in the Pharmacotherapy Treatment Relationship,” 5) “Transference and Counter-Transference,” 6) “Managing Split Treatment,” and 7) “Managing Difficult Cases”. The format is a series of brief case vignettes leading to discussions on the specific topics. Most vignettes will sound too familiar as they emphasize our successes and failures with making the “correct” or “incorrect” verbal or nonverbal intervention during treatment. Chapters 4 and 5 are by different guest authors. They are repetitive (and in my opinion unnecessary) and do not quite flow with the rest of the book.
The book provides a plethora of clinical pearls that will be of value to all clinicians. How to ensure a relationship with a patient in the 15-minute hour that will enhance treatment adherence, emphasizing the “we” in the relationship, encouraging patients and families to ask questions, keeping the phone lines open, and being flexible about the options available in pharmacologic interventions are all interventions typically practised by good clinicians but seldom documented in a readable text for others to model. I particularly enjoyed the techniques for dealing with patients who present with the latest Internet reviews and who wish to switch treatment based on the latest American television commercials about a different drug or what his or her neighbour thinks. I enjoyed the techniques for dealing with comments by an incredulous pharmacist about your prescriptions, who may undermine more of our efforts than we think. It was a welcome relief to hear the authors state that there comes a time during medication intervention when the truth about the limitations of further aggressive chemotherapy is the most compassionate and therapeutic action we can offer a treatment-resistant patient.
This is a valuable and quick read for all psychiatric clinicians who prescribe medications. It is particularly valuable for busy, time- pressured clinicians in mental health centres and chronic care facilities and for psychiatric residents attempting to bridge and consolidate psychotherapeutic and pharmacotherapeutic interventions.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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