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Psychoanalysis On and Off the Couch

Feb 16, 2020

The guiding principle in using psychopharmacology within psychoanalytic treatment is to see under which circumstances and how far the patient’s autonomy and the patient’s feeling of agency is well preserved. Or you might speak of the degrees of freedom enabled or being hindered by the use of pharmacology.”


Description: Harvey Schwartz welcomes Dr. Joachim Küchenhoff, who is a psychoanalyst and a member of the IPA and of the Swiss and German Psychoanalytic Societies. He is also a specialist in psychiatric psychotherapy, specifically in psychosomatic medicine. Dr. Küchenhoff was the medical director of the department of the adult psychiatry in the canton Basel-Stadt in Switzerland from 2007 to 2018 and he is the editor in chief of the Swiss Archives of Neurology, Psychiatry, and Psychotherapy. Dr. Küchenhoff has written 16 academic books and edited 22 academic volumes. He is especially interested in psychoanalytic transdisciplinary research and has collaborated intensively with philosophical, cultural and literary scholars. His latest publication in English is a monograph called Understanding Psychosis: A Psychoanalytic Approach. His scientific work centers on the psychoanalytic approach to severe psychic disorders in psychiatry and especially in psychosomatic medicine, and on the subjective body experience.


In today’s conversation, Dr. Küchenhoff dives deep into helpful use, as well as not so helpful use, of psychotropic medications in patients during psychotherapy and analysis, emphasizing the relationship this has with the patient’s autonomy.


Key takeaways:

[7:01] Dr. Küchenhoff shares his perspective on the role of psychotropics in psychotherapy.

[10:05] The importance of treating severely ill patients psychoanalytically who are using drugs or need them.

[11:04] The role of the patient’s autonomy.

[12:54] Dr. Küchenhoff presents a case example.

[17:56] Dr. Küchenhoff shares a case example where it was unnecessary to prescribe drugs to the patient.

[22:30] The issue of split treatment.

[25:35] Dr. Küchenhoff talks about countertransference and its relationship with the prescription of psychotropics.

[26:50] Treating the roots of depression.

[30:55] Dr. Küchenhoff explains why he considers himself a psychoanalyst in the first place.

[34:50] Psychoanalysis can be successfully applied to many diverse fields of medicine.


Mentioned in this episode:

IPA Off the Couch


Recommended Readings:


Understanding Psychosis: A Psychoanalytic Approach. Routledge London, Joachim Küchenhoff 2018.


Intercorporeity and body language: The semiotics of mental suffering expressed through the body.Joachim Küchenhoff, IJPA 100 (4) 769 – 791, 2019


Proving the impact of psychoanalysis on daily psychiatric practice. In: Eizirik C, Forrest G (ed.) Psychoanalysis and psychiatry. Partners and competitors in the mental health field. P.243-255. Routledge London, 2019.


Psychoanalyse und Psychopharmakologie [Psychoanalysis and psychopharmacology; book in German]. Kohlhammer Stuttgart (ed.), 2016.