ABSTRACT
This chapter elucidates relevant considerations for optimizing care when the therapist prescribes. The skill set for the combined function goes beyond a dual capacity to engage in psychotherapy and prescribe medication. However, while a therapist in a split treatment must be mindful of how a medication-responsive condition is affecting the patient and his or her treatment, the need for vigilance is attenuated because the therapist can reasonably assume that the pharmacotherapist is periodically doing a careful assessment. Abel-Horowitz describes, with unusual candor, his work as a candidate analyst with a male patient while his supervisor strongly discouraged the use of medication. Roose have raised concerns as to how the reliance on free association as an essential dimension of dynamic work can hinder pharmacologic management. An awareness of the risks of enactment, the need to interrupt free association for systematic assessment, and technical problems emanating from side effects increases the likelihood that the psychiatrist will be effective in providing combined treatment.
