Although psychiatric drugs have traditionally been regarded as the mainstay of psychiatric treatment, evidence now suggests they are over-prescribed and that a large proportion of people struggle to reduce or withdraw from them. With prescriptions doubling over the last 10 years, most psychological therapists are now working with clients who have either taken or are currently taking psychiatric drugs. However, a recent survey of over 1,200 BACP, BPS and UKCP therapists found that most felt a need for support when working with issues of prescribed drug dependence. Only 7% of those surveyed felt that their training equipped them ‘very well’ to work in this area, and 93% reported they would find it either ‘useful’ or ‘very useful’ to have professional guidance to help them work with clients who are taking or withdrawing from psychiatric drugs.
In response to this need for support, during the 2017–2019 parliament the All-Party Parliamentary Group for Prescribed Drug Dependence facilitated the creation of the Guidance for Psychological Therapists: Enabling conversations with clients taking or withdrawing from psychiatric drugs1. This provides up-to-date evidence and information about the main effects of psychiatric drugs and the possible withdrawal reactions associated with them. It also invites therapists to consider and work with a wide range of issues associated with prescribed psychiatric drugs where they arise in therapeutic work. The full guidance is extensive, so this short-read version has been created to summarise some of the main issues and implications for practice in a more convenient and accessible format. For further information, you are advised to consult the full version of the guidance here.
Given the diversity of therapeutic backgrounds, professional trainings and practice settings, neither the full guidance nor this short-read summary aims to be prescriptive. No formal ‘competences’ or guidelines are suggested. Instead, you will be encouraged to consider whether and how you might begin to integrate issues of prescribed drugs into your therapeutic practice. The following guidance will support you by:
- Providing information about the main effects, adverse consequences and possible withdrawal reactions for each of the main classes of psychiatric drugs.
- Helping you to understand how and when prescribed psychiatric drugs might impact the therapeutic relationship and process.
- Supporting and empowering you to talk about prescribed drugs with clients and, where appropriate, with prescribers.
- Enabling you to support clients in whatever decisions they reach with prescribers about taking or withdrawing from psychiatric drugs.
- Encouraging you to reflect on your own attitudes and beliefs about the use of prescribed psychiatric drugs.
This guidance aims to empower and support conversations that may already be taking place between you and your clients. You will need to decide for yourself whether, and to what extent, you wish to use it in the context of your therapeutic work. This decision will depend on your modality, setting, and the individual needs of your clients. The client’s agency, as always, should be supported and respected at all times. Clients should be encouraged to discuss withdrawal from prescribed psychiatric drugs with a knowledgeable prescriber who can give medical advice, oversee and manage any withdrawal process appropriately. While this guidance advocates the importance of informed client choice based on full information about potential benefits and risks, it does not advocate telling your clients to take, not take, stay on or withdraw from psychiatric drugs. These matters should be left to the prescriber and your client to decide.