Family members can have a significant influence on a client’s initial decision to attempt psychotropic medication. They can also influence the client’s willingness to adhere to a treatment regimen once it has been started. This is because most clients live in families, and they are affected by their loved ones’ responses to their choices. For these reasons, clinicians should welcome input from members of the client’s family. After all, the responsibility of caring for a client usually falls on family members. They are not simply uninvolved bystanders.
For example, it is common for family members to prompt or even coerce a client into making the initial appointment with the clinician. However, due to the stigma of mental illness, and the client’s concerns about being a burden to family members, the family may not be fully aware of the client’s mental health status. This lack of knowledge often results from fractured relationships in the family and the client’s preference to keep family members out of the loop.
Although only a few studies have examined the interaction between families and psychotropic medication, we can still extract some clinical wisdom from the sparse literature. It makes sense that caring families would be concerned about their ill family member and would therefore be affected by his or her behavior. These studies tell us, however, that while a collaborative approach to treatment – one that includes family members – works best, seldom are families consulted about medication or educated about the ill client’s condition. Of similar concern is how little clinicians utilize family members as collateral sources of information about the ill client’s previous history.
Why not? Well, family work is time-consuming, and clinicians are often hamstrung by clients that won’t submit to signing informed consent documents that would allow the family to participate in treatment. Family work can be cumbersome from a standpoint of scheduling appointments – getting them together can be like herding cats. Time constraints fueled by managed care-imposed restrictions on the number of sessions clinicians can have with clients makes it all the more easier to overlook family member input. There’s also the family’s belief system regarding medication to consider. In spite of these obstacles, clinicians are encouraged to engage clients in permitting family to participate in treatment decision-making. Clients who believe their family members have a supportive interest in their improvement are often more willing to submit to a psychotropic medication evaluation. That’s because caring families hope that medication- accompanied by other non-pharmacological, psychosocial treatment strategies – will ease their loved one’s suffering. This can also improve relationships between the client and their family.
When getting the family on board, explain the rationale as to why you believe a psychotropic medication evaluation is worth considering for their loved one. Have a healthy respect for family members’ views and experiences about medication, but do challenge faulty belief systems with determination. Offer reading material and Web addresses to help ensure that family members have as much information as possible. And do answer any questions they may have straightforwardly, as you need as many allies as you can get when you invest in client success.
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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.