The Need for Integrated Treatment: Synergistic Aspects of Psychotherapy, Psychopharmacology, and Patient-Provider Dynamics in Clinical Practice.

Abstract

Psychiatry has long been considered a biopsychosocial discipline, but, in the age of evidence-based medicine, clinical care is becoming increasingly fragmented and manualized. We continue to separate "biological" and "psychological" modalities in spite of mounting evidence that psychotherapy has a direct impact on brain physiology, and that psychopharmacological treatments carry meaning that often determines its real-life effectiveness. Evidence-based treatments (EBTs) focus clinical attention on the patient's symptomatic presentation and functional capacity that define their generic DSM-5 diagnosis. Yet, understanding the person of our patients and their experience of the illness goes beyond static diagnostic labels and involves exploration of their unique subjective and relational dynamics. Therapeutic alliance, a major factor in the treatment outcome across both psychotherapeutic and psychopharmacological modalities, has become increasingly marginalized as more psychiatrists shift toward single consultation practices, where the full scope of the relational meaning is largely lost. Conversely, the minority of practitioners who continue to offer psychotherapy are often less familiar with psychopharmacological modalities. Although psychopharmacology and psychotherapy are both clinically effective, their outcomes and cost-effectiveness are further enhanced when they are applied in tandem, in the context of a nurturing relationship with the treatment provider. Below, we examine the limitations of the current EBT paradigm and the evidence for an individualized integrated wellness model that relies on empirically supported principles of care.