He was 23, a college senior, and lit up when he talked about photography, something he loved.

But every time his excitement broke through, he crushed it with the same line:
​“I just need to get my shit together and be more like my dad.”

His dad wanted him to push harder, climb faster, succeed bigger.

But my patient wasn’t even sure he even wanted that life.

And me?

I just wrote him another prescription and sent him on his way.

I maxed him out on Strattera, watched him become poorly compliant, and then never saw him again.

That’s on me.

The medication seemed to be working for his symptoms, but was it helping?

Because what he really needed wasn’t another titration schedule.

He needed someone curious enough to ask...

What does it mean to you if your meds work?

And what if they don’t?

Whose voice is in your head when you swallow that pill?

Did growing up with a diagnosis feel helpful or make you the family scapegoat?

What kind of “care” did you really receive from past doctors and caregivers?

But here’s the truth: most prescribers don’t ask those questions.

We’re trained to listen for symptoms, follow the algorithms, and adjust doses.

That’s exactly what I did with him.

And it’s not just me.

For the past few decades, psychiatric training has leaned hard into the “medical model.”

Biology. Neurotransmitters. Receptors.

It was meant to de-stigmatize mental illness and be more “this isn’t your fault, it’s brain chemistry” but it also stripped out the psychology, which might be the most important part!

The results?

• Less curiosity about a patient’s story
• Less time spent on meaning, ambivalence, or unconscious dynamics
• More patients who feel “broken by biology” instead of empowered to work towards wellness

It’s not that the science is wrong. It’s that the story got lost.

And when the story is lost, the alliance suffers.

And when the alliance suffers, outcomes suffer too.

This week's video is about psychodynamic psychotherapy and how it impacts treatment outcomes!​

If my patient had had you, a savvy, thoughtful therapist, in the room, you could’ve stepped in!

You could have named the ambivalence, helped him explore why he didn’t really want medications, and guided him toward what might’ve worked instead.

This is the heart of psychodynamic psychopharmacology.

It’s not just about receptors and doses. It’s about the story.

...The narrative your client carries into the room.

...The way unconscious feelings about illness, identity, and authority sneak into treatment.

But if the story doesn’t change, the outcome rarely does.

As a therapist, here's you can help:

• Ask your clients what story they’re telling themselves about taking meds
• Listen for fear, relief, failure, or resentment hiding underneath
• Bring curiosity where my system usually brings scripts

The best medication in the world won’t fix a bad narrative and no algorithm can replace the power of curiosity!

Help me undo some of the damage from the medical model as psychiatry tries to regain some of it's humanity (and let's make it a little more fun too!)

Cheers to healthy brains,

Dr. B
Jessica Beachkofsky, MD MSCP
Your friendly online psychiatrist!

P.S. Here's your video link for psychodynamic psychopharmacology!​

P.P.S. And as mentioned in the video, here's the link to Amazon for the book by Dr. David Mintz ​

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