Dr. Roy Resnikoff is a clinical professor at the UC San
Diego School of Medicine and the author of the 2001 book "Bridges for
Healing: Integrating Family Therapy and Psychopharmacology." I contacted
him after reading an article of his published in 2002 in the Psychiatric Times
about his use of meds in couples therapy.
Resnikoff believes drugs can be useful in couples therapy to
control symptoms, improve communication, modulate biological temperaments
related to personality issues and reduce stress.
I was struck by this paragraph:
"I believe sorting out biological from learned factors
in personality style will help form the basis for using medications to enhance
personality flexibility. New research on biological aspects of attachment
continues to evolve. For example, Young et al. (2001) have described oxytocin
and pitocin as neurotransmitters that enhance attachment behaviors in
animals."
Four years after he wrote that passage, there's intense
interest in exploiting the connecting and bonding effects of oxytocin for
people with autism or other social disorders, and at least two drug companies
are working on oxytocin-based drugs. So, I wanted to ask him what he thought
now about the prospects for oxytocin in therapy.
Susan: Let's talk more about modulating biological
temperaments. First, what exactly is a biological temperament?
Dr. Resnikoff: I'm borrowing from the work of Larry Seaver
and Paul Soloff, who described four main biological temperaments: people who
are a little detached, people somewhat negative or depressed, violent or semi-explosive
and anxious/fearful. With medication, if you can tweak some of those inborn
temperaments to make someone less detached, less depressed, less violent or
fearful, then they may be more able to tolerate therapy and deal with the
issues in their life.
Susan: Is personality dependent on biology?
Dr. Resnikoff: Most psychiatrists say it's about 40 percent
genetic; the rest is based on environment. We're born with tendencies and
depending on upbringing or culture that will be brought out. It's an
interaction of genetic vulnerabilities and whatever happens to you that will
determine your personality.
Susan: Does psychotherapy deal with the 60 percent?
Dr. Resnikoff: Yes. But psychology can also alter the 40
percent that's biological; you can retrain certain biological tendencies --
whether obsessiveness or other things, sometimes you can do a lot of that
without medication.
Susan: And how would you use psychopharmacology to modulate
such?
Dr. Resnikoff: These temperaments are in a continuum with
diagnosable symptoms. Each category has different types of medication that
seems to be useful, even if someone doesn't have a diagnosable condition. For
example, low doses of an antipsychotic can help schizoid people, those who are
somewhat autistic or detached. If a person is anxious and fearful, serotonin
help and various tranquilizers might help.
Susan: How you use drugs as an adjunct to psychotherapy?
Dr. Resnikoff: It depends on the case. If a person comes in
initially, and they have panic attacks, are manic, or paranoid, they may need
some medication right away to deal with the immediate crisis. Very commonly in couples
therapy, I don't introduce medications for a couple of months because there's no
obvious crisis. It's more about managing the temperaments. Three to six months
down the road, when they know me and I know them, I explain that part of
problem seems to be a temperament issue that's biological, and we may be able
to modify that issue right there.
Susan: I'm sure you've gotten criticism from people who
think it’s wrong to medicate to change behavior. How would you respond?
Dr. Resnikoff: If it's just a matter of giving oxytocin to
correct the problem, it reduces all problems to biological issues and doesn't deal
with the overall problem. If you're realistic, oxytocin might help a person
feel a little more attached, but unless that's reinforced and the dynamics of
the disattachment were looked at, that would be bad practice to assume things
are just totally biological.
For example, I'm working with a new couple where the husband
had an affair three months after they were married. He was terrified by the
entrapment and emotional demands of the marriage. He really wants to be married,
he was just overwhelmed by needs of the wife, which weren't excessive. I can
imagine that, in his case, some oxytocin might facilitate his tolerating the attachment
and closeness of a marriage.
Susan: Are there limitations to a pharmaceutical approach to
bonding?
Dr. Resnikoff: Definitely. That would just be a small part
of the equation, to tilt things in the direction of an attachment. There are so
many different dynamics … to explain why a person is not attached. Medication
by itself would not be enough to take care of all the factors.
Susan: Many people seem to hope that a shot of oxytocin could
be a panacea for loneliness or isolation. What would you tell them?
Dr. Resnikoff: It's a factor, and I do use medications to
help create a tendency toward treating whatever problem you have, but we have
to look at the context of your relationships and background. I'd want to wait
quite a while before including a medication, and I'd minimize the impact of
medication as having only a small effect.
Regarding oxytocin, we will have to wait to see the actual
clinical impact on people with various types of attachment problems.
I specialize in the use of medications for couples to
promote therapy and connection, but that's just a small part of my practice,
and [use of] oxytocin would probably be the same.
