How Do You Discuss Medication With Hesitant Patients?

In my experience, it is helpful to talk about the preconceived ideas about medications in general. For example, do you take medication when you are physically sick? Have a headache? Do you know or have known anyone who has had to take medication to stabilize their blood pressure or diabetes? Manage symptoms of gout? Can you talk about that?

From that conversation, I would move into how medication for mental health challenges would be in a similar category as medications taken for blood pressure, diabetes, gout, etc. Often, clients feel that by taking medications for mental health symptoms, it is because they are weak or cannot handle stress, life, etc.

As a therapist, my clients often share with me their hesitations about medication and may be looking for my input. Ultimately, I have to remind them that I am not a prescriber and therefore there are some things that I cannot speak to. After we’ve had a chance to level-set that portion of the conversation, I try to really hear their concerns. I think this is the part the prescribers most often miss.

Often, a client wants to try talk therapy first. Other times, they tell me how sensitive they are to medicines. I also often hear worries about side effects or the belief that they won’t be themselves. “I don’t want to just take a happy pill.” We start by validating all of it. We talk about how therapy is good, and medications can be good too. The problem is that we hear “together they are better,” and I’m not sure this is always the case, but I do think that together they cover more ground, as it were.

If a client is considering medications and is still hesitant, we work to help them voice their concerns and preferences to their provider. I “grew up” as a psychologist working on treatment teams and am very comfortable working with psychiatrists and PCPs regarding a client’s care. When I am able, I try to help my clients by continuing this collaborative care model. This means that sometimes we all agree that waiting to start a medication is a good idea.

Other times, it means that after a period of working in therapy and time on a medication, it can be time to taper off the medicines. I always urge people to have a conversation with their medication prescriber about the medicines, side effects, and potential withdrawal effects, and just because you are offered a medicine doesn’t mean you have to take it, nor does it mean that you shouldn't. Each situation is unique and different. Ultimately, I cannot tell clients what to do when it comes to medication, but I can help them learn how to use their voice, ask questions, and increase their comfort with the decision they make for themselves.

Considering medication can be a challenging decision. If you're not sure about medication but have symptoms that are interfering with your life, I recommend consulting with a psychiatrist to gain a deeper understanding of your diagnosis, even if you ultimately decide not to take medication. This consultation can provide valuable insights into your mental health and available treatments.

Medication, particularly in the early stages of mental illness (and I use that term very broadly), can help your brain change its habitual ways of functioning. This can be especially beneficial when combined with psychotherapy, as it may 'take the edge off' and make it easier to practice new skills and process emotions.

I'd also like to add that some people think of psychiatric medication as changing who they are. However, SSRIs (a common type of medication), for example, don't add neurotransmitters to your system. Instead, they work by making the existing neurotransmitters more available to your brain, helping you feel more balanced and ready to engage in therapeutic work.

It's worth learning more about your own symptoms and diagnosis and how medication could help you.

I always approach the topic of medication by first trying to understand my client's viewpoint. I will ask my client to list out their specific fears so that I can have a better understanding of their hesitations. Then, I would discuss the potential benefits medication could have on my client's specific symptoms.

If my client has been in contact with a prescriber, we would explore the specific medication together in session. I would help my client craft a list of questions for their prescriber regarding their concerns. If my client chooses that medication is not the right fit for them at this moment, I will validate and respect this decision, but let them know that we can always revisit this discussion in the future. If my client is hesitant to start medication, I will offer suggestions for laddering steps toward medication, such as journaling, movement, or CBT techniques. I will provide my client with the space to continue to explore their hesitations, fears, and symptoms to ensure they are getting the best possible treatment and care for their mental health concerns.

I share with my patients that, while I am not a huge fan of unnecessary medication, there is a time and a place where it is helpful. I explain that, in order to better address their mental health issues, their physical biology needs to be stabilized. I explain that it is nearly impossible to work through complex mental health issues when they are struggling with significant mood-altering diagnoses. Once stabilized, we will have an easier time addressing the underlying issues. I also assure them that I will maintain contact with their prescribing psychiatrist to ensure that we are all on the same page regarding treating their issues.

When approaching the sensitive subject of pharmacotherapy with clients who are apprehensive, I employ a model of shared decision-making (SDM), an approach endorsed by the American Psychiatric Association (APA) and substantiated by research in The Lancet Psychiatry. Shared decision-making is a collaborative process where the clinician provides balanced, evidence-based information about the benefits, risks, and potential side effects of medication while respecting the client's values, preferences, and personal agency.

I typically begin by normalizing their hesitancy, acknowledging common concerns about dependence, side effects, or the stigma attached to medication. This paves the way for a transparent, non-coercive dialogue. I also introduce the concept of medication as one component of a multimodal treatment plan, which might include psychotherapy, lifestyle interventions, and behavioral strategies. For clients who fear loss of control, discussing pharmacogenomics—the study of how an individual's genetic makeup affects their response to medication—can be particularly helpful. Recent advances in this field, published in JAMA Psychiatry (2021), allow for more personalized pharmacotherapy, which often alleviates concerns about adverse effects.

Finally, I emphasize that pharmacotherapy is not a permanent or binary solution, but a potential adjunct to therapy that may help stabilize symptoms sufficiently to allow deeper psychological work. This integrated, compassionate approach tends to reduce resistance and fosters a sense of empowerment in the client’s treatment journey.