When starting to work with clients who are taking, or thinking of taking, a prescribed psychiatric drug, you may wish to:
- Explore sensitively and with care how your client understands their psychological difficulties and whether they are ready to discuss taking prescription drugs.
- Enquire whether your client’s prescriber has discussed with them all the possible effects of, and potential for dependence on, any proposed drug. It is important to encourage your client to discuss this with their prescriber if they have not already done so.
- Think about whether and to what extent taking prescribed psychiatric drugs is likely to affect your client’s experience of therapy. If this is a first appointment, you may decide that it is not in your client’s best interests to start therapy. You may choose instead to refer them to alternative sources of help and support to either manage distress or withdraw from such drugs. However, given the lack of currently available services, you should remain cautious about assuming other professionals are better able to offer emotional or psychological care. Therapists are generally well placed to offer support to withdraw (ideally with a prescriber advising on a reduction plan), though it may be necessary to adjust therapeutic expectations of what kind of work will be possible whilst it is taking place.
You will also need to take care not to offer any personalised suggestions about the advisability or otherwise of taking prescription psychiatric drugs. Any specific questions about the type, dosage or frequency of psychiatric drugs should be referred back to the prescriber who can give medical advice. As this is an emerging area of knowledge, however, not all prescribers will necessarily be aware of the need for, and how to plan, a slow reduction. Clients may need signposting to relevant information that will give them the confidence to ask for a prescriber’s support with this.
Questions to help you reflect on your practice, either on your own or in supervision:
- What does my client think and feel about taking prescribed psychiatric drugs?
- Why does my client wish, or feel they need, to accept (or not) a prescription?
- What is my client’s relationship with their GP or prescriber? How can I best support my client’s choice either to start taking prescribed drugs or to revisit the GP/prescriber to consider alternatives to drugs?
- Is my client directly requesting advice about drugs? If so, can I support their agency in relation to the prescription? Do they need more information?
- Have I been clear about the distinction between medical information and advice?
- What is the likely impact of the proposed drug on my client’s ability to engage in psychological therapy?