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Psychiatric Drugs: What Therapists Need to Consider

Just because therapists don’t prescribe psychiatric drugs, doesn’t mean we can’t support our clients to explore their impact. Ahead of a live PESI UK webcast training in April, psychiatrist turned Person-Centered Counsellor Rachel Freeth draws our attention to the various ways in which drugs may affect our clients and the therapy – and suggests we have a key role to play in holding space for subjective meaning.

The rate of prescribing most categories of psychiatric drug has increased dramatically in recent years. One consequence of this is increasing numbers of therapy clients taking one or more psychiatric drug. While it might be tempting for therapists to think that drugs are the sole concern of the prescriber and conversations about drugs should stay within the medical arena, this would be misguided.

Psychiatric drugs are powerful psychoactive substances that have a range of effects on the brain and the body, both the intended effect and a host of unwanted, potentially adverse effects. In different ways (through different mechanisms of action in the brain) drugs can alter both cognitive and emotional experiencing, for example, slowing down thought processes (a sedative effect) or suppressing emotions. While they are intended to treat mental disturbance and distress, it cannot be assumed that taking a psychiatric drug will be of benefit to the person taking it, i.e. whether altering a person’s cognitive and emotional functioning will be helpful. Or if it does provide some therapeutic benefit, does this outweigh any potential negative effects?

What, then, might be some of the implications of working with a client who is taking a psychiatric drug? How might its effects – including effects the client feels are beneficial, and those that are unwanted and unpleasant – interfere with the therapeutic process or even the goals of therapy?

It is not just important to consider how the direct physiological effects of drugs might be affecting the client’s thought processes and emotions, and what therefore they bring or are unable to bring into the therapeutic space. It is also important to consider what actually taking a drug might mean for the client in terms of how they interpret it. For example, how does taking a drug influence how a person sees themselves and understands their difficulties and distress? Do they now view themselves as mentally disordered or ill? Do they think of themselves as defective or flawed? Is taking a drug seen as a moral weakness? Or might it inspire hope that something is now being fixed or attended to, or even just simply something ‘being done’? 

Of particular importance is to consider whether and how taking a psychiatric drug influences a person’s view of and attitude to therapy. Furthermore, might having therapy and taking a psychiatric drug complement each other, or could there be some inherent conflict? This is complex. It is also, in my experience, an area that is often overlooked and not given much consideration, perhaps precisely because it is complex. For starters, it means considering our very understanding and theories about the origins of the disturbance and distress these interventions are targeting. It means thinking about the helping frameworks, or models, within which we practice and the messages they convey. It might also mean being aware of how different forms of help influence personal agency and what expectations are created about intended benefits.

It is quite likely that discussing the subjective meanings of taking a drug is not given any time in the consultation with the prescriber. Even those doctors who are interested in subjective meanings will often lack time to have this kind of discussion. To my mind, then, the therapy space can provide a valuable opportunity for the client to explore how they feel about the drug they are taking, or weigh up the pros and cons of taking it. Therapists may also support clients to come off a drug, taking account of important guidance such as that produced by the All-Party Parliamentary Group for Prescribed Drug Dependence (APPG)(2019), which you can access here.

Rachel Freeth will be delivering a live webcast training for PESI UK, Psychiatric Drugs and Mental Health Made Simple: Everything Therapists Need to Know to Feel Confident with Prescriptions and Medications, 8-9 April 2021. Click here for more information and to register.

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Rachel Freeth

Rachel Freeth has worked as an NHS psychiatrist for nearly 25 years, during which time she has worked in a variety of different mental health settings. She currently works as a community psychiatrist in Herefordshire, England. Rachel also trained in person-centred counselling in the late 1990s and has most recently worked as a counsellor in the voluntary sector.

For a number of years she has been delivering workshops on subjects related to psychiatry and mental health, many of which are designed for counsellors and psychotherapists. Both through delivering training and writing she aims to bridge the different worlds of psychiatry and counselling. See for further details of her publications, including her first book Humanising Psychiatry and Mental Health Care: The challenge of the person-centred approach (2007). Oxford: Radcliffe Publishing. She lives with her partner in Gloucestershire.  

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