The Sometimes Rocky Road toward a Psychotropic Medication Evaluation

Throughout the many years I have practiced psychotherapy, one area where I still consistently encounter client ambivalence is the use of medication to augment therapy treatment. Years ago, when I was a novice psychotherapist, I believed that clients would go along willingly with the suggestions and recommendations put forth by their trusted therapist. Not so! Most clients, just like us, assess the odds associated with considering alternative options for some time before actually committing to the behaviors that drive the start of the change process. So it is essential for any clinician who refers a client for psychotropic medication to be clear about the diagnosis, the potential benefits of medication versus its risks, and the client’s belief system about their disorder and its treatment.

medication_evaluationClient ambivalence therefore, is a common occurrence, but when faced with this, clinicians should take the opportunity to continue strengthening the therapeutic relationship as the decision making process unfolds. Patience is the key here, as any attempt to rush a client into a premature decision is likely to backfire and possibly compromise the relationship moving forward. However, waiting for patients to make their decisions does not mean a clinician cannot offer an opinion. I consider it an obligation to voice my views on the most viable, literature-grounded alternatives available. I ensure that my patients have as much information as I can provide so that they can make informed choices about their future treatment.

With this in mind, here are a select few of the markers to take into account when considering a referral for psychotropic medication with a patient:

  • – The patient is not responding favorably to psychotherapy, despite an adequate trial period. For me, this is number one.
  • – There is a complicated medical history and the patient is taking multiple medications. Never underestimate the negative influence that certain medical disorders and some prescription medications can have on client improvement.
  • – The patient hasn’t had a thorough physical examination in years. There may be an undiagnosed medical condition that is impinging upon what the client sought treatment for in the first place.
  • – The patient initially presents with prominent mood and behavior instabilities, or mood and behavior become more markedly labile as psychotherapy continues.
  • – There is an active and identifiable presence of psychotic features exhibited by the patient. This is evidence of a biologically based disorder, for which pharmacological intervention is the mainstay of treatment, with psychotherapy as an adjunct to care.
  • – A prolonged personal history or significant family history of mental disturbance.

Substance abuse may be associated with the person that repeatedly experiences relapses after some improvement. Also, many disorders are highly heritable. Genetic predispositions often are associated with neurochemical deficits in the brain that can have an adverse influence on sustained symptom improvement unless pharmacotherapy is considered.

Understandably, deciding as to whether or not to pursue psychotropic medication for their condition is a challenge for many clients, so encourage them and their family members to ask questions they may have so as to demystify the decision making process. And it’s worth remembering that particularly when it comes to medication, clients will make their own choices, on their own terms, in their own time.

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Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, Psychopharmacology: Straight Talk on Mental Health Medications is available at www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.