[Medication in triangles. On expectations and meaning in pharmacotherapy]

When prescribing medication, psychiatrists operate at the intersection of pharmacotherapy and psychotherapy. On the one hand, psychiatrists focus on receptors, genes, and pharmacodynamics, and on the other, on environmental factors, trauma, and the meaning medication has acquired in interactions with others.

To provide insight into the psychological and interactional aspects important in prescribing medication, and how to manage them.

Based on psychotherapeutic knowledge, I argue that these aspects are an important part of prescribing process.

Key psychotherapeutic principles important in prescribing are evaluated. In the therapeutic relationship and in the effective handling of countertransference, expectations and meanings emerge. To put this into practice, a model is introduced – two triangles- to facilitate understanding and manage meaning of medication during the prescribing process. The ‘conflict triangle’ describes dealing with an internal conflict, while the ‘person triangle’ concerns relationships in the present and the past.

Prescribing psychopharmaceuticals requires knowledge of biological pathways, but also the proper application of psychotherapeutic skills. Managing these various aspects properly is the art of the profession. After all, it’s not just about what we prescribe, but also how we do it. Skillful and effective use of psychotherapeutic skills is likely to reduce the risk of side effects and enhance efficacy. The two triangles can be helpful in easily understanding and managing the meaning of medication during the process of prescribing.