1. Introduction

Psychiatric drugs such as antidepressants and antipsychotics are more prescribed today than at any other time in our profession’s history. Around a quarter of the UK adult population was prescribed a psychiatric drug last year, with around 16% being prescribed antidepressants (2016–17) (DHSC 2018).⁹ The steep rise in prescriptions (which have broadly doubled in the last 20 years¹⁰) means that most therapists now work with clients who have either taken or are taking psychiatric drugs. Some people will report experiencing positive effects from taking these prescribed drugs, even describing their effects as ‘life-saving’. Others will report no beneficial effects and/or adverse effects that are severe and often protracted. Whatever the reported effects, the evidence indicates that a large proportion of people struggle to reduce or withdraw from their prescribed psychiatric drugs. To date, the lack of summarised evidence, information and training for therapists who work with clients experiencing withdrawal effects constitutes a growing problem for therapists whatever their modality or work setting.

This lack of knowledge and training is reflected in data gathered from a 2018 survey of approximately 1,200 practising therapists – all members of BPS, UKCP or BACP. While 96.7% of the therapists reported that they currently work with at least one client who is taking a psychiatric drug (e.g. an antidepressant, anxiolytic or antipsychotic), only 7.3% reported that their training equipped them ‘very well’ in responding to questions about withdrawing from or taking psychiatric drugs. Additionally, 42.5% of therapists reported feeling a lack of confidence in knowing where to find appropriate information (or ethical or professional guidance) on how to work in the most therapeutic way with people taking or withdrawing from psychiatric drugs. This lack of support, training and information may well explain why 93.1% of the therapists surveyed reported they would find it either ‘useful’ or ‘very useful’ to have professional guidance to help them work more competently and confidently with such clients.

It is therefore now essential for the therapeutic professions to respond jointly to this growing need for clear guidance about how best to work with and support clients either taking or withdrawing from psychiatric drugs. This guidance seeks to provide such support in two distinct ways:

Firstly, it aims to support therapists in deepening their knowledge and reflection on working with the said client group. The evidence reviewed in this guidance means that therapists will now have access to an up-to-date summary of the main effects, adverse consequences and possible withdrawal reactions for each of the main classes of psychiatric drug. Using this evidence base, the guidance aims to empower therapists to talk about prescribed drugs with their clients (and where appropriate with prescribers) as well as to identify and work with the impact that psychiatric drugs may exert on the process of therapy itself.

Secondly, it invites therapists to familiarise themselves with core issues relating to the role of psychiatric drugs in therapy. Many therapists prefer to avoid discussing the client’s relationship to prescribed psychiatric drugs, assuming any consideration or discussion of this relationship is best left to prescribers. This preference may be rooted in feelings of anxiety about navigating alternative views on psychiatric drugs, not having sufficient knowledge to engage other professionals, or feeling uncertain about managing the boundaries of one’s professional competence or role. Indeed, while this guidance agrees that it is not the role of the therapist to tell a client either to take, continue to take or withdraw from psychiatric drugs, nor to decide when, if or what drugs need to be withdrawn, this guidance actively encourages therapists to support clients in whatever decisions they reach with their prescribers. It also encourages them to engage with the views and perspectives of other professionals whilst at the same time honouring the distinctive and important contributions therapists can make in supporting a client through withdrawal from psychiatric drugs. Finally, it is also important to note that this guidance does not aim to disrupt or comment on the NICE guidelines as used by medical doctors, which, for example, recommend drugs for many conditions in addition to psychological therapies. However, it is also important to note that NICE’s recommendations are continually being updated in the light of new debates, disputes, interests and evidence. For example, at the time of writing the guideline on depression (CG90) is undergoing an additional period of consultation in response to criticisms from a coalition of stakeholders, which includes many therapy organisations.