Mistake to make: Telling your therapy client they need meds

The irony of psychotherapists recommending medications is that doing so is exactly what clients do NOT want.  Over the last few days, I ran into several research articles, which found psychotherapy was preferred over medications at a ratio of 2:1[i] another found a ratio of 2.8 to 1,[ii] while another found that psychotherapy was preferred nearly 5 times more often than medications.[iii]  Similar results are found in studies of the general public.  In a review of 10 studies, positive attitudes to psychotherapy were 2.3 times more prevalent than to antidepressant medications.[iv]  Some of the reasons expressed as to why psychotherapy was preferred include a belief that psychotherapy can get to the actual cause of the depression, concerns about medication side-effects, and concerns that medications are addictive. Thus, among depressed patients, and the general public, psychotherapy is strongly seen as the treatment of choice over medications, for a variety of reasons.

So, the pressure for psychotherapists to recommend medications may come from the titanic influence of drug company advertising and influence over the medical profession, and the desire of psychotherapists to be accepted by the medical profession.  It is opposite to what clients want.  I want to encourage all of you to be strong, privilege your client’s voices and goals, regardless of the pro-pill environment.

Eric Kuelker, Ph.D. R.Psych.

[i] M Dwight-Johnson, CD Sherbourne, D Liao, KB Wells (2000) Treatment Preferences Among Depressed Primary Care Patients, J Gen Intern Med, 15:527-534

[ii] Backenstrass MJoest KFrank AHingmann SMundt CKronmüller KT (2006) Preferences for treatment in primary care: a comparison of nondepressive, subsyndromal and major depressive patients. Gen Hosp Psychiatry. Mar-Apr;28(2):178-80

[iii] Lowe B, Schulz U, Grafe K, Wilke S, (2006) Medical Patients’ Attitudes Toward Emotional Problems and Their Treatment. What Do They Really Want? Journal of General Internal Medicine,  21, 1, 39-46

[iv] van Schaik DJKlijn AFvan Hout HPvan Marwijk HWBeekman ATde Haan Mvan Dyck R. (2004) Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry. May-Jun;26


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