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.