From Dyad to Triad: On Psychodynamic Meanings of Psychiatric Treatment

The professions of psychiatry and psychotherapy are both complementary and competitive. This paper examines the dialectic tension between the two. It observes the complexity in having psychiatric evaluation and treatment in the context of ongoing psychotherapy. A referral to a psychiatrist is a meaningful, and a charged intrapsychic and interpsychic event for the patient as well as for the two therapists involved. The nature of the triangle is affected by the inner worlds of the three participants; therefore, the more awareness to the shared work, the better the communication between the three sides of this triangle. The referral to a psychiatrist by a psychotherapist is described as a specific type of an enactment in which the therapeutic dyad is becoming a tirade with all the implications attached. As opposed to the dichotomous perception of the psychiatric intervention as a temporary interruption and reduction of the therapy, this paper offers a model of cooperation between professions that will create a wider and deeper therapeutic space.