Abstract

Background: Medications can have a wide range of symbolically mediated effects on patients and these effects can be positive or negative. When medications serve conflicting countertherapeutic goals, action, including deprescribing, may be needed to ameliorate them.

Method: Drawing on work with complex, treatment-refractory patients, we have identified strategies to inform and guide practitioners encountering meaning-based counter-therapeutic medication effects.

Conclusion: These include the development of an overall diagnosis, a focus on the therapeutic alliance, addressing pathogenic meanings of medications and approaching deprescribing as an interpersonal process.

Keywords: Deprescribing, psychodynamics of pharmacology, therapeutic alliance, counter-therapeutic medication, biopsychosocial, psychiatry.