THE ‘NO MEDICATION’ MYTH
Back in the day, when I first started practicing psychotherapy, most psychological therapists considered psychoactive medication to be a ‘no-no’. That’s why, back then, most of us usually tried to persuade our clients not to take psychotropic drugs. However, that was never an easy thing to do. That’s because in those days it was popularly believed that there was a ‘pill for every ill’. The benzodiazepines, (Valium, Librium, etc.), were thought to be everybody’s ‘little helpers’. GPs gave them out like Smarties, (or M & Ms if you come from the USA). The second generation anti-depressants, (Tricyclics or MAOIs), were pretty commonly available too. In fact, there was no shortage of mood altering medications of any kind. Got a problem? Pop a pill – problem solved!
From its early days, psychotherapy’s more purist theorists have never been happy with pill popping They were convinced that the psychotropic drugs only masked the symptoms; they didn’t fix the underlying psychological problems. That’s why, back in the ’80s and ’90s, the usual psychotherapeutic ‘must do’ was to get patients to stop taking their psychotropic medications and to start talking to their therapists instead. That was then, it’s a very different story today. These days, it’s the clients who seem to be reluctant to use any form of medication, psychopharmacological or otherwise. Nowadays, the big problem is persuading our clients who really do need psychoactive drugs to actually start using them.
It doesn’t help that all too many counsellors and psychotherapists still cling to the historically ‘right on’, fundamentalist, attitude that the psychotropics are inherently ‘bad things’. Mental health should never be ‘medicalised’ they say. However, these ‘holier than thou’ purists, with their dogma driven mind-sets, are ignoring the evidence. Modern research clearly shows that the right sorts of psychoactive medication can be very helpful in the right sorts of circumstances. This doesn’t mean that all our clients should be on medication – far from it. What it does mean is that sometimes some of them would benefit if an appropriate mood altering drug was part of the treatment package. Psychotherapists, just like everybody else, should never say never, especially where psychoactive medication is concerned.
Today, more and more psychotherapists and counsellors are accepting that there are occasions when some clients really do need psychopharmacological interventions. In fact, for some psychological disorders, medication is more than just helpful, it is essential. Even in cases where one of the talking therapies is usually the preferred treatment, sometimes a medication-driven ‘emotional boost’ is necessary before the patient can begin to respond to psychological therapy. Put simply: In some cases, no pill means no talking therapy.
So why do all too many counsellors and psychotherapists still persist in pressuring their clients into choosing between medicine or the talking therapies? Why not offer them the best of both worlds? As an everyday practitioner, one who is very much non-purist, I often find that pills and psychotherapy in combination can be very effective. Certainly not in every case, certainly not for all my patients, but certainly for about 15-20% of my case load. Check out the advice leaflets that accompany most prescribed psychoactive medication. Most of them say something like – “this medication should be taken in conjunction with counselling or psychotherapy”. For some of our clients that’s good advice.
Of course, if you are going to work with patients who use psychoactive medication you need to know about the medical models of mental health. Check them out. You also need to know all about the standard psychiatric medications and how they work. My own book, ‘Mental Health in Counselling and Psychotherapy’ would be a good place to start. You will also need to be aware of the psychological impacts of many of the commonly encountered physical disorders. For instance, did you know that there is a link between heart disease and depression? Don’t forget that many routinely prescribed medications can also have mood altering side-effects. It’s not difficult to find all this out. Go on-line or read some books. If you want to know more about a specific medication, then it’s a good idea to learn how to search the British National Formulary. The BNF is a mine of vital information. Again, it’s all on-line.
Psychotherapists cannot separate themselves from the world of conventional medicine. At the very least they need to know how a patient’s current medical condition, and any associated treatment or drug regimes, might impact on that patient’s psychological being. There are of course many medications and many physiological conditions that need to be borne in mind when planning out a series of psychotherapeutic interventions. For example, would you know what to do if a client tells you that he or she is taking Lithium or Quetiapine? What if a client has hyperthyroidism or diabetes? Did you know that some psychotropic medications, (the antidepressant Amitriptyline for example), have their uses in non-psychological treatments? Is your client really having a panic attack or is it a heart attack? Clearly psychotherapists are not doctors, they do not have the specialist knowledge. However, they can find out, and they should find out, what medical science can tell them about their clients’ needs. Obviously, the best sources of information are the patients’ GPs but your local pharmacists can be very helpful too. Never forget, if all else fails, Dr Google is always on-call, 24/7.
Finally, it’s important to keep in mind that we are only psychotherapists. We are not mental health wonder-workers, (surprise, surprise!). Sometime patients present with psychological or psychiatric issues that are outside our spheres of competence. Do you know how and where to refer such patients on? How familiar are you with your local psychiatric and mental health services, both NHS and private? Do you know what to do if a client presents with some worrying physiological symptoms? If you can’t confidently answer these sorts questions, then now is the time to find out how to do so. Tomorrow you might bevery glad that you did!