In a previoius article I addressed The Shame Factor and Ambivalence as common reasons why clients resist psychotropic medication (read this article). This article discusses two other common reasons for resistance: Family Interference and Fear.
Family Interference
Let’s face it, family members are our de-facto healthcare specialists. They have likely witnessed the unpredictability and even the anguish associated with the mental health struggles of their ill family member. In this sense, they are not merely uninvolved bystanders. So for clinicians that want to practice in a context of collaborative care, expanding the scope of treatment to include the family is a must. Clients who believe their family members have a supportive interest in their improvement are typically less resistant to the use of psychotropic medication. Unfortunately some family, because of belief systems ingrained over many years, actually encourage their ill family member to resist medication treatment.
How you can help: Have a healthy respect for family members’ views and experiences about medication, but do challenge faulty belief systems – such as “mental illness is a character flaw,” “medication is for crazy people,” or “medication doesn’t work” – with determination. Offer reading material and Web addresses to help ensure that family members have as much information as possible. Answer any questions they may have straightforwardly, as you need as many allies as you can get throughout the treatment process.
Fear
Two often expressed issues that invoke clients’ fear of psychiatric medication use are: (a) medication will, in some way, “change who they are,” or alter their personality, and (b) although their troublesome symptoms may improve, intolerable side effects will be possibly worse than the illness itself.
How you can help: It is imperative that a clinician stress that prescribed medications (not illicit drugs, of course) do not alter core personality, nor do they change someone into something they are not. Explain that medication does not change behavior, but has the capacity to ameliorate symptoms that are wreaking havoc in the client’s life. Inform the client that all drugs have side effects and that some may indeed be of concern. For example, lithium is linked to possible coma and even death, but such circumstances are very rare and are most often associated with individuals that misuse this drug and don’t comply with the required blood work. In the end, clients need to know that only they can make the decision to get better. So ask your client “are you willing to tolerate some weight gain as a trade-off for feeling better and becoming more functional?” “If weight gain becomes a bothersome issue, would you commit to working on diet modification and a regular exercise regimen?”
One of the most challenging dilemmas for clinicians is respecting a client’s decision to resist medication use even in the face of continuing, and sometimes debilitating symptoms. Theres a fine line between coercing vs. encouraging medication use, and the misuse of power in the clinical relationship can undermine client self-determination. So it’s worth remembering that when it comes to medication, clients will make their own choices – on their own terms and in their own time.
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Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, Psychopharmacology: Straight Talk on Mental Health Medications is available at www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.