Combined Psychotherapy and Somatic Treatments

Growing evidence shows that combining psychotherapy and somatic treatments is more efficacious than employing either modality alone in treating a range of psychiatric disorders. As most psychiatric disorders are multifactorial in etiology, effective treatment requires a comprehensive and multifaceted approach that holistically addresses the biopsychosocial aspects of illness. Additive and interactive effects are thought to underlie the increased efficacy of combining treatments over a single approach. Pharmacotherapy and other somatic treatments such as electroconvulsive therapy predominantly address the biological aspect of illness. Yet, psychological factors such as transference reactions and placebo and nocebo effects, significantly affect response to treatment. Similarly, while psychotherapy has traditionally been thought to address the psychosocial aspects of illness, recent research has demonstrated that the process of psychotherapy has salubrious neurobiological effects. Combining psychotherapy and somatic treatments is a complicated undertaking that involves either a single clinician integrating both treatment approaches or collaboration between two or more clinicians. Either approach requires the clinician to skillfully navigate various challenges and pitfalls such as fragmented care, splitting, or resistance. The common factors of psychotherapy such as a good therapeutic alliance and a caring, empathic, and collaborative approach form the cornerstone of any effective treatment relationship. Furthermore, the clinician should be sensitive to cultural influences on delivery of care and on the patient’s experience of illness, help-seeking, and treatment preferences.