The Role of Medication - My Philosophy

I am generally not the kind of therapist to jump to suggesting that someone consider starting medication.  Sometimes, however, medication can serve as a valuable component to helping people make progress with the struggles that they come into therapy with.  Generally speaking, I’m not in favor of using medication without therapy, at least in the beginning.  In a lot of cases, if someone starts out on medication, my ultimate goal is to see if they can grow and improve enough that they can gradually wean to either a lower dose of medication or come off of it completely.  How to go about making the decision about whether or not medication is right for you is a decision that you will need to make with your doctor or psychiatrist, and consulting with your therapist about the challenges that you have come to therapy to work on and how they relate, or don’t relate, to medication is an important part of the therapy process.

In most cases, I like to work with the person first to get to know them and see how therapy alone works out.  Important exceptions to this are when a person’s safety is an issue because of deep depression and serious suicidal thoughts, they are dangerously explosive and a risk to others, they are in an abusive relationship that they want to leave but haven’t been able to, or their symptoms are so severe that they are prevented from leaving the house to get to school, work, and therapy.  In these situations, a referral to a psychiatrist to be considered for medication is valuable and crucial.

When immediate safety is not an issue, getting to know a person first, without medication, is ideal because it can possibly prevent the need for medication to be used at all.  An advantage here, of course, is that you avoid exposing people to possible side-effects.  Additionally, I feel that there are many struggles that are a normal part of life or a normal response to a particularly challenging life, and that, when possible, it’s ideal to help people to: be comfortable with finding acceptance with the fact that they are struggling because they know that struggling with challenges is normal; navigate the “lows” of a challenge and get through them to a “better place” by building/reinforcing supports and coping skills; and foster a sense of resilience and strength that they can tap into again, in future times of need.

Therapy plays a critical role in helping people to tap into their existing strengths as well as to develop new ones. The only time that I am in favor of medication alone is after someone has done the work in therapy. I do believe that some people’s bodies are more hardwired for struggle than others. In terms of whether to start medication at all, from my perspective, medication can lessen the intensity of some types symptoms so that it’s easier for the individual to develop confidence and beneficial skills, shifting directions to a positive, “growth” spiral rather than a negative, inhibiting one. Creating new habits is hard, takes time, and can be much more difficult to do when symptoms are overwhelming, crippling, and interfere with basic needs like safety, nutrition, and sleep.

Of course, there are people who are afraid of the medication itself or experience too many side effects. If their symptoms are relatively mild, most people make significant, meaningful progress on their own.  One thing I would like to note here is that, in my practice with individuals who have particularly intense anxiety symptoms, I have found that these folks can still make significant gains without medication and often the gains are more meaningful to the person and long-lasting because of how hard they worked on achieving them, but the process can be slower, sometimes significantly so.  However, there can still be a downside here because of the potential damage to their self-image that my clients have reported to me. When you have very intense symptoms that have really held you back from living your life and moving forward with things like academics, family, or career, it can add a layer of trauma on top of the person’s original symptoms.  With trauma comes feelings of shame and self-loathing, and this then gets added to the figurative pile of things that need to be addressed in therapy.

Clearly, taking medication to address psychological “symptoms” has it’s advantages and disadvantages.  A good therapist can play an important role in helping you sift through the information, in conjunction with a medical doctor (including psychiatrists), to help you determine what you feel is the right decision for you.