Kombinierte Psycho- und Pharmakotherapie unter besonderer Berücksichtigung von Kurz- und Notfalltherapie
Authors: Bellak L. 
Published: February 2010

‘Nihil est in intellectu quid non antea fuerit in sensibus’, said Hume. And Freud formulated the hypotheses concerning the translation of experience into personality under the influence of drives and other somatic variables. Psychoanalytic treatment is predicated upon reversing that process and restructuring maladaptive gestalten. This therapeutic process can and must be carefully conceptualized in terms of our knowledge of propositions concerning personality and psychopathology. Brief psychotherapy can accomplish a good deal of the necessary unlearning and re-learning when it is especially carefully conceptualized and areas and methods of intervention and their optimal sequence clearly formulated. Pharmacotherapy can aid psychotherapy in general and brief psychotherapy in particular if its use is also carefully integrated into the overall therapeutic process. A relatively simple <i>clinical</i> use of psychotropic drugs consists of employing them as <i>enabling</i> conditions for patients who could not communicate otherwise because of a depression, impulse disorder, disordered thought process, etc. In other instances it may enable patients to tolerate phobias and other circumstances to avoid reality complications until the psychotherapeutic process does the necessary work – using the drugs as if they were analgesics. At times they are used like anesthetics to perform psychotherapeutic interventions which might otherwise cause more pain and anxiety than the patient could tolerate without breaking off treatment, becoming too disturbed or block because of approach anxiety. A <i>dynamic</i>, in fact, a metapsychological, use of drugs can be made if one gives a drug to decrease drive pressure, as with chlorpromazine in the case of aggression. It is possible that lithium performs its particular function by increasing the stimulus barrier externally and internally. Antidepressants may generate energy and are thus seen by some as changing the psychic economy. A combination of major tranquilizers and energizers is sometimes indicated for optimal synergistic effect. The ability of phenothiazines and relatives to suppress primary process modes of thinking can be seen from either a dynamic or topographical perspective. It would be desirable to have a drug that could weaken superego forces. While the superego may be dissolved in alcohol, the process is neither reliable nor practical. A <i>psychobiological</i> basis for using drugs in psychotherapy is inherent in the catechol-amine hypothesis and others conceptualizing the etiology and pathogenesis of the psychoses in biochemical terms. There is little doubt that there is a continuous interaction between experience and a broad spectrum of biochemical processes, including cortisol and growth hormone excretion. Diurnal variations of secretions have almost certainly an effect on cognition and eventually drugs and psychotherapy related to these biochemical changes are likely to become especially efficacious. Similarly neurophysiological factors in disturbances, like minimal brain disfunction, need special medication to optimize the ability to communicate in psychotherapy and control impulses, concept formation and anxiety.