The question most often asked in the psychopharmacology seminars and trainings that I conduct across the country is this: “How do I professionally and ethically handle the client that continues to resist psychotropic medication in spite of continuing symptoms?”
In this article, I’ll address four common reasons why clients resist psychotropic medication and offer strategies you can utilize to assist them in understanding how medication may serve as a viable option for their condition. Let’s begin with The Shame Factor and Ambivalence.
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 their negative self-talk. Emphasize that the 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. You might add that drugs 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.
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.
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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.