The rapid growth of scientific and medical knowledge can make it difficult for any professional guidance to keep up with the speed of change. This means there is scope for differences of opinion amongst those providing care for the client. Unfortunately, there is no specific guidance available on how therapists should respond to ethical issues relating to taking or withdrawing from psychiatric drugs. However, the general ethical principles provided by all main professional accrediting bodies remain important touchstones. These include:
- Working with informed consent
- Respecting a client’s best interests
- Keeping knowledge and skills up to date
- Demonstrating accountability and candour
- Working respectfully with colleagues.
Working in therapy with issues of prescribed psychiatric drugs raises particular ethical questions that relate to boundaries of professional competence, modality and role. For example, clients may ask you for medical advice and information and you can quickly find yourself drawn into discussions about drug choice, dosage and frequency. It is important here to distinguish between providing medical advice and providing medical information. Discussing scientific evidence, sharing information from a reputable source, or offering a different perspective where appropriate with clients differs substantially from offering a diagnosis, prescribing drugs or advising withdrawal. It is important to be clear about this distinction with clients and it can bear repeating. Clients requiring advice on psychiatric drugs should always be referred to their medical practitioner or a knowledgeable prescriber. But helping a client to understand the potential advantages and disadvantages of taking prescribed psychiatric drugs during therapy can be thought of as part of your responsibility to ensure your client’s informed consent for the work you do together. This is different from the prescriber’s responsibility to inform the client about the physiological and psychological effects of their prescribed drugs. It can, of course, be helpful for you to support this process where appropriate, for example by directing clients to relevant sources of information.