Clients come to therapy with many beliefs and assumptions about psychiatric drugs. Many people believe, or have been told, that depression, anxiety and other psychological problems are caused by biochemical changes to the brain, while others believe there are genetic factors underlying their emotional distress. In these cases, psychiatric drugs carry a strong psychological ‘message’ that the individual has an ‘illness’ and requires medical ‘treatment’ in order to cope. Clients may also believe that it is not good for them to experience strong feelings of distress, and that psychiatric drugs will quickly and effortlessly get rid of feelings of sadness or anger. In these and many other situations, you will need to sensitively explore the beliefs and meanings held by the client, taking into account their particular experiences as well as any unrealistic expectations they may have about psychiatric drugs.
As we have seen, prescription psychiatric drugs act on the brain to alter mood and consciousness sometimes helping to control reactions to emotional distress by numbing, sedating or tranquilising a person. While some clients will find the effects of psychiatric drugs helpful, they can result in a range of adverse effects, which may significantly impact the therapeutic relationship and process. Some of the possible effects on thinking, feeling and behaviour are listed below:
Adverse effects on thinking may include:
- memory impairment
- poor recall
- poor concentration
- confusion
- losing track of ideas
- difficulties in making links
- difficulties in structuring thought
- problems staying focused
- inability to retain insights over time.
Adverse effects on feeling may include:
- emotional withdrawal, being less able or willing to connect with a therapist
- being uninvolved, distanced or ‘not really there’
- inability to reconnect with feelings relating to past experiences
- suppressed anger, sadness or fear
- lack of emotional congruence.
Adverse effects on behaviour may include:
- passivity with the therapist
- passivity outside therapy sessions
- uncooperativeness or overcompliance
- denial of responsibility
- absences due to lateness, cancellations or missed appointments
- apparently poor motivation
- repetitive speech or behaviour
- disengagement from work or social activities
You will need to bear in mind that many of the effects listed here can also be part of the experience of emotional distress. You may therefore wish to consider exploring with your client whether any perceived effects on thinking, feeling and behaviour could have been evident before they took the prescribed drug.