How Do Clinical Psychologists Assess the Need for Medication Versus Psychotherapy?
Psychologist Brief
How Do Clinical Psychologists Assess the Need for Medication Versus Psychotherapy?
In the complex field of mental health, deciding between medication and psychotherapy can be a game-changer. Insights from a Board certified Counseling Psychologist and a Psychiatrist shed light on this critical decision-making process. The discussion kicks off with evaluating severity and functioning levels, and wraps up by exploring a client's willingness for medication, with a total of five expert insights in between. This collection of professional perspectives provides a comprehensive understanding of patient assessment in mental health care.
- Evaluate Severity and Functioning Level
- Administer Diagnostic Scales
- Consider Multiple Key Factors
- Assess Symptoms and Root Causes
- Discuss Client's Willingness for Medication
Evaluate Severity and Functioning Level
In my practice, I generally evaluate the necessity of medication by carefully examining the severity of a patient's symptoms and their functioning level in daily life. When a patient displays marked distress, such as a significant loss of appetite, persistent trouble sleeping, or even thoughts of self-harm, I consider the possibility that medication may play a crucial role in their treatment. Moreover, if there is a notable family history of a specific mental health disorder, it can often suggest that the patient's symptoms may stem from genetic or physiological factors. This insight is important, even though I recognize that environmental and contextual elements can contribute to their condition. Understanding this interplay aids in providing a comprehensive approach to their care.
Administer Diagnostic Scales
I will administer certain scales, such as a PHQ-9 or GAD-7, among others, to determine whether the patient will benefit from medications. If the patient has moderate-to-severe symptoms, as well as challenges in functioning at home and/or at work, then I will suggest that medication is beneficial. If the scores suggest mild symptoms and few to no challenges in functioning, then I will suggest psychotherapy alone. Sometimes a combination of both medication and therapy is best, depending on the patient's symptoms and functioning.
Consider Multiple Key Factors
Whether to use medication, psychotherapy, or a combination of both in treating a mental health patient is actually a difficult choice, which often requires much deliberation and involvement between the patient and the treating physician.
Key considerations would include:
Symptom Severity and Impairment
Acute, Severe Symptoms: Symptoms that are severe and disabling, which highly impede functioning, will likely require medication to bring the patient's symptoms under control quickly.
Chronic and Pervasive Symptoms: Psychotherapy is likely better suited for chronic conditions since it can deal with causes and teach ways of coping.
Patient Preference
Personal Beliefs: Patients' personal beliefs may make them either support or oppose medication.
Past Experiences: Past experiences with medication can make a patient apprehensive about retrying it.
Underlying Causes
Biological Factors: When the biological component is great in mental health, medication may work better.
Psychological Factors: If major psychological factors such as trauma or negative thinking patterns are strongly contributing to the disorder, psychotherapy may be more beneficial.
Comorbid Conditions
Medical Conditions: There may be other co-occurring medical conditions that could exacerbate the symptoms of a mental health disorder; therefore, medication may be warranted.
Substance Abuse: If substance abuse is present, then medication can help in dealing with withdrawal signs and cravings.
Side Effects and Risks
Medication Side Effects: Each patient has the right to know about the possible side effects that might be linked with the medication since some of those side effects could outweigh the benefits.
Side Effects of Therapy: Even though psychotherapy generally presents fewer side effects compared to medication, the course of psychotherapeutic treatment can be emotionally exhausting and requires a lot of time and effort.
Ultimately, what will be most effective in a person's case will depend on a series of factors that must be worked out individually. The interplay of a patient, therapist, and psychiatrist will go a long way to offering a comprehensive approach to treatment.
An important point to remember is that drug and psychotherapy approaches are not mutually exclusive. On the contrary, in most cases, optimum results may come from the use of both therapies together.
Assess Symptoms and Root Causes
The severity of their symptoms and the root cause(s) play a big role. While generally, medication and therapy together have a synergistic effect that gives better and faster results, there are times when we favor one over the other. A person experiencing anxiety at a new job due to imposter syndrome won't find relief in medication. A person with limited financial or time resources might not be able to commit to therapy, so medication alone may be the best fit. As a psychiatrist, I will sometimes have patients whose symptoms are so intense that they can't yet tolerate therapy around the issues that will help them most. My goal in these situations is to utilize medication to stabilize them so they can better tolerate the work in therapy. A prime example is severe OCD—when someone feels so powerless against intrusive thoughts and resisting compulsions, they get to the point of tolerating exposure and response prevention (ERP) work much faster with the aid of pharmacologic intervention. The most important thing to know is that this is fluid—choosing the best approach for someone in this season of their life will be different than in others.
Discuss Client's Willingness for Medication
The first question is whether the client wants to try medication. If they do, I'll refer them for a consultation with their PCP or a psychiatrist. If they're resistant to the idea of trying medication, but have severe symptoms that I think could be helped with medication, I'll say, "Well, let's try talk therapy alone for a period of time to see if that can help your symptoms, and circle back in a while and reassess. When do you think we should take another look at that?"
