Treatment by a psychotherapist and a psychopharmacologist: transference and countertransference issues

Recent surveys suggest that collaborations between psychiatrists acting as medication consultants and therapists providing psychotherapy are an increasingly common form of treatment. Complex transference and countertransference reactions can arise in these "therapeutic triangles." Risks include splitting by the patient, conflicts between the two practitioners, and premature termination of either the psychotherapy or pharmacotherapy. The authors discuss typical transference and countertransference reactions that can lead to these problems and present case examples of productive and unproductive collaborative efforts. The authors describe a collaborative approach based on mutual respect, trust, and openness that, along with an awareness of typical transference and countertransference issues, can increase the likelihood of a positive treatment outcome.