[Long-acting neuroleptics in the therapeutic relationship. I. General considerations]

In spite of their recognized effectiveness with psychotic pathologies and their unquestionable therapeutic advantages, long-acting neuroleptics, in use for more than a decade, still generate more bewilderment and resistance than other medicines. Within the profession, it is assumed that the difficulties associated with their use are related to the interference of subjective experience in the rational motivations of therapy. The strictly inherent aspects to the therapeutic relationship are taken into consideration in an attempt to systematize the subjective implications of the psychiatrist who prescribes the medicines and the patient who takes them. Experiences of rejection and/or total acceptance of the drugs are traced in the patient: these experiences are often determining factors in the progress of the therapy. These observations lead to an evaluation of the importance of the therapeutic relationship and the psychotherapeutic aspects this takes on during the course of chemotherapy. Thus the use of long-acting neuroleptics presents special difficulties connected with the fact that they create new means of communication in the patient, means which the psychiatrist must take into consideration in his relationship with the patient.