In this final installment of my blog series on helping clients overcome resistance to psychotropic medication I address how fear impacts decision making. Previous posts have examined The Shame Factor, Family Interference and Ambivalence.

fear24. Fear. Two often expressed issues that invoke clients’ fear of psychotropic medication 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 use 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. There’s a fine line between coercing vs. encouraging medication use, and the misuse of power in the clinical relationship can undermine client self-determination. Also 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.