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One perhaps unintended consequence of the evacuation of the field of psychotherapy by the younger generation of psychiatrists is the increasing unawareness of the influence of countertransference in determining their treatment of their patients. If you do not learn about its power to deceive in psychotherapy, you will be unaware of its constant sabotage potential in all therapeutic endeavors, including prescription of medications and evaluation of their efficacy.

There have been numerous impassioned pleas by my colleagues to block the black-box warning on SSRI drugs so that millions of children (and their parents) might be spared possible suicide from the beneficial effects of these medications. One of the defenses of the drugs is that they enhance the ease with which adolescents talk about suicidal ideation and therefore enhance treatment. This is a clinical observation that deserves respect, but it is presented in such an urgent manner that ignores the fact that we have other means (including other medications) that enhance the process of communication between child and professional that are available to knowledgeable treating physicians.

One has to wonder about the vehemence of the objections produced by counter-transference issues that are not expressed. If drugs are restricted for possible safety and efficacy issues in children, the profession should react to it as “God's work” to be aided by scientific inquiry we can trust. The FDA, if belatedly, did the right thing by putting a warning on the medications and should also tighten its approval procedures.