Symbolic Meaning of Drugs in Psychotherapy: A Psychodynamic Perspective

Compared with the huge number of research on psychotropic drugs (PDs), and their wide use made to manage the symptoms of psychological and psychiatric disorders, little attention has been devoted in providing a psychodynamic interpretation of their symbolic meanings during psychotherapy. Our theoretical contribution, based on a critical overview of 5 decades of literature, focuses on the psychodynamic meaning attributed to PDs, and examines how their role in transference- countertransference exchanges depends on patients' personalities and psychological traits, considering recent acquisitions also in the study of the placebo-nocebo effect. We therefore describe how the symbolic meaning of PDs can be mutually shaped by the therapeutic dyad during the treatment. Clinical vignettes are used to illustrate how the therapist's ability to understand the symbolic meaning of PDs can be crucial in the clinical process and, consequently, for the outcome of treatment. The potential influence of the meaning attributed to PDs on the neuroscientific perspective is also discussed. Neglecting the psychodynamic processes related to PDs may lead to negative consequences in many domains of patients' treatment, including a lack of adherence and a failure of the therapeutic alliance. Future challenges should include exploring new transference paradigms in the light of an encouraged interest on the meaning attributed to PDs in therapeutic relationshi