Helping Clients Overcome Resistance to Psychotropic Medication: Strategy #4

In this final installment of my blog series on helping clients overcome resistance to psychotropic medication I address how fear impacts decision making. Previous posts have examined The Shame Factor, Family Interference and Ambivalence.

4. Fear.   Two often expressed issues that invoke clients’ fear of psychotropic medication are:

(a) medication will, in some way, “change who they are,” or alter their personality, and

(b) although their troublesome symptoms may improve, intolerable side effects will be possibly worse than the illness itself.

How you can help: It is imperative that a clinician stress that prescribed medications, (not illicit drugs, of course), do not alter core personality, nor do they change someone into something they are not. Explain that medication does not change behavior, but has the capacity to ameliorate symptoms that are wreaking havoc in the client’s life. Inform the client that all drugs have side effects and that some may indeed be of concern. For example, lithium use is linked to possible coma and even death, but such circumstances are very rare and are most often associated with individuals that misuse this drug and don’t comply with the required blood work. In the end, clients need to know that only they can make the decision to get better. So ask your client “are you willing to tolerate some weight gain as a trade-off for feeling better and becoming more functional?” “If weight gain becomes a bothersome issue, would you commit to working on diet modification and a regular exercise regimen?”

One of the most challenging dilemmas for clinicians is respecting a client’s decision to resist medication use even in the face of continuing, and sometimes debilitating symptoms. There’s a fine line between coercing vs. encouraging medication use, and the misuse of power in the clinical relationship can undermine client self-determination. Also it’s worth remembering, that when it comes to medication, clients will make their own choices – on their own terms and in their own time.

Helping Clients Overcome Resistance to Psychotropic Medication: Strategy # 3

The third reason fostering client resistance to psychotropic medication is ambivalence. Here I address that issue, and how you can help.

3. Ambivalence.

Practitioners at all levels of experience know that getting clients to overcome their resistance toward psychotropic medication is not necessarily easy. Many clients assess the odds associated with considering medication options for some time before making the commitment to following through with pharmacotherapy as part of the treatment process. A client’s decision therefore may be long and drawn out.

How you can help: Patience is the key here. Any attempt to rush the client into a premature decision is likely to backfire and could also compromise the therapeutic relationship. Of course, waiting for clients to decide does not mean a clinician cannot offer an opinion. On the contrary, if the clinician knows that evidence-based literature supports a pharmacological treatment of a particular condition, (for example, bipolar disorder) this information should be conveyed to the client. Again, offering reading material or reputable Web addresses can help ensure that clients have as much information as possible. Encourage them to ask questions. Straightforward answers help to demystify the decision making process. In this way, the client can make informed choices regarding the importance of medication for their particular disorder.

Helping Clients Overcome Resistance to Psychotropic Medication: Strategy # 2

Last week, I discussed the “shame factor” as a reason for psychotropic medication resistance and/or refusal, and addressed some ways for helping your clients overcome shame issues. This week’s post focuses on family interference and how you can help.

2. Family Interference.

Face it clinicians, family members are our de-facto healthcare specialists. They have likely witnessed the unpredictability and even the anguish associated with the mental health struggles of their ill family member — your client. In this sense, they are not merely uninvolved bystanders, so for clinicians that want to practice in a context of collaborative care, expanding the scope of treatment to include the family is a must. Clients who believe their family members have a supportive interest in their improvement are often less resistant to the use of psychotropic medication, but unfortunately, some family members, because of belief systems ingrained over many years, actually condone resistance to medication use setting up a potential treatment dilemma.

How you can help: Have a healthy respect for family members’ views and experiences about medication, but do challenge faulty belief systems – such as “mental illness is a character flaw,” “medication is for crazy people,” or “medication doesn’t work – with determination. Offer reading material and Web addresses to help ensure that family members have as much information as possible. Answer any questions they may have straightforwardly, as you need as many allies as you can get throughout the treatment process.

Helping Clients Overcome Resistance to Psychotropic Medication: Strategy # 1

Why are some clients so resistant to the use of psychotropic medication? After all, it is a treatment strategy that has garnered rather widespread acceptance as an option for treating a vast array of mental health maladies isn’t it? Over my next four blog entries, I’ll address four common reasons why clients refuse or even downright resist medication, together with strategies you can utilize to assist them to better comprehend why medication just might be a viable alternative for their condition.

1. The Shame Factor.

Shame is often experienced as the voice in our clients’ head that judges what they do as wrong, inferior or somehow worthless. Clearly these shaming inner voices can do considerable damage to clients’ self esteem. For some clients, this critical judge is continuously providing a negative evaluation of what they are doing, moment-by-moment. If medication is mentioned as a treatment option, negative self-evaluation can kick into overdrive resulting in faulty, illogical conclusions. Two common conclusions that clients reach are: (a) they have failed themselves because their own attempts to remedy their condition haven’t worked, and (b) they must therefore be “really sick.”

How you can help: Work first with the client on the negative self-talk. Emphasize that resolution of their presenting problem is a journey that may include several different directional paths, and that medication is merely one of them. Explain that medications are not necessarily essential and that they are not demeaning or even redemptive. Medications are merely an option to possibly help kick-start symptom improvement, and that they can be discontinued – preferably after consultation with their therapist and the prescriber – if the client so wishes.