Medical model versus Psychodynamic theory

The word "iatrogenic" is almost exclusively used to mean an adverse effect or complication related to the provision of health care.  The word "iatrogenesis" really refers to both the good or bad effects related to but not the actually intent of the actions of a healer.  So, why is iatrogenesis almost always used to refer to negative effects? I could just say that many who use the term in this manner are control freaks and think anything that happens that they did not will to be is therefore bad.  But, then this would be a short post.  Instead I will focus on how I believe that the emphasis on the negative points to what I believe is the essential difference between the medical/behavioral model and psychodynamic theory.

The medical/behavioral model, in my opinion, operates on the assumption that what is critical in the success of an intervention is not the interventionist, it is the quality of the intervention itself.  A medication will be successful if it is the appropriate medication at the appropriate dose.  A homework assignment will be successful if appropriately presented, conducted, and reviewed.  The only concern for the exact nature of the relationship between a healthcare recipient and a doctor is that it be professional.  Anything that occurs that was not expected from the intervention is interpreted as due to "error" or a "placebo effect."  

Psychodynamic theory, conversely, is very concerned with the nature of the relationship between the psychologist and the client.  The concepts of transference and counter-transference clearly emphasize that it is the therapeutic relationship which is the critical component of healing.  When anything occurs that was not expected from the intervention, it is interpreted as informative about the client's personality, history, and presenting problem.  The unforeseen improvement or insight is considered a boon not a burden.  

Then what should we do with undesired, unforeseen, negative results of intervention?  How should we react to institutionalization -- an iatrogenic effect of long-term care?  I believe psychodynamic theory indicates that we should understand the dynamics of the relationship between the client and the institution.  For example, does a client become institutionalized because at some level the hospital unwittingly promotes that result?  Or could it also be that a battered soul will choose the safety of a cell over the responsibility and dangers inherent in freedom? Such informed analyses could potentially lead to both policy and procedural change that could reduce the incidence of institutionalization.  With the current emphasis on the medical/behavioral model, I am doubtful that such analyses will be performed, let alone operationalized, in the near future.  But, it is a seed that should be planted and nurtured by new, up-and-coming doctors -- psychiatrists as well as psychologists.