Medication Considerations For Non-Prescriber Clinicians:
Ethical and Clinical Considerations
By Ofer Zur, Ph.D.
The issue of medication comes up often in clinical consultation and psychotherapy treatment. As consumers have become more empowered and better informed, psychotherapists are hearing an increased number of questions about psychotropic medications and treatment options. Considering the brief time that family doctors and PCPs spend with their patients (some estimate it at about eight minutes per visit) clients are left uniformed and often with many unanswered questions. There is hardly an agreement in the field whether the use of medication is necessary, helpful or harming. These debates are most prevalent around the medication groups of anti-anxiety, antidepressant and ADHD medications. Regretfully, outcome research about the benefits of medication vs. verbal psychotherapy is often motivated by turf wars and economic interests rather than by science or clients’ welfare. While most people with mental illness consult their family doctors first, many psychotherapy clients wonder whether medication can help them or not.
Following Are Some Basic Facts And Suggestions For Non-Prescribing Clinicians.
- Therapists should have some general knowledge and understanding about psychotropic medication. They do not need to be experts in this area but should have some basic knowledge of whether outcome research has indicated that medication may be helpful for certain clients and certain conditions.
- Considering the option of medication is like any other clinical consideration, which must be applied according to the context of therapy. The context of therapy includes client, setting, relationships, orientation and therapist factors. In other words, suggesting medication as an adjunct or in place of verbal therapy may be appropriate in one context but may not be in another.
- Non-prescriber therapists can discuss with or suggest medications to clients with the clear understanding that they do not have the authority to prescribe. Suggesting to clients that medication may help, and they should discuss it with a prescribing clinician is not ‘practicing medicine without a license.” It is important to help our clients make informed decisions by helping them understand their options in regards to medications’ potential benefits and side effects.
- Non-prescriber therapists may discuss and suggest medications to clients and prescribing clinicians, while making it clear that the ultimate decision regarding all aspects of medication is with the prescriber clinician and not with the non-prescriber therapist.
- Psychotherapists are often in the best position to suggest or evaluate medication because, in most situations, they see the client much more frequently and for longer periods of time than the medicating clinician.
In Some Situations It May Be Advisable For The Non-Prescriber Therapists To Consult With The Prescribing Clinicians. These Situations May Include:
- Client experiences significant or severe side effects that the prescriber clinician may not be aware of.
- Clients are non-compliant and notifying the prescribing clinician can help the treatment.
- If the non-prescribing clinician may want to suggest different doses or different medication all together.
- If client, who is a suicidal risk, is taking medications that they can overdose on.
- Client may feel embarrassed to discuss certain issues, such as impotency, with their prescribing doctor but feel more trusting to share it with their psychotherapist.
- If the psychotherapist is not sure what medication and what doses were prescribed.
- Client is abusing drugs or alcohol, which can adversely affect the metabolism of psychotropic agents or cause dangerous drug interactions.
- Prescribing clinician decides to discontinue medication and treating therapist thinks it is either premature or clinically ill-advised.
- In summary, non-prescriber therapists should communicate with prescribing clinicians if, in their assessment, such communication may be helpful to the client. In other words, the best interests of the patient should determine whether the non-prescriber therapist should be engaged with prescribing clinician.
While Consulting With Prescribing Clinician, Non-Prescribing Therapist Should:
- Obtain an authorization to release information. Even though HIPAA law allows psychotherapists to discuss medication and other treatment issues with medicating clinicians, most state laws require that therapists, in most situations, obtain client authorizations before disclosing any confidential information to the prescribing clinician.
- Provide only the minimum information necessary.
- Be careful with the release of information related to people who are not your clients but are related to the client, such as spouses, children, parents, etc.
- Suggest different medication, different doses or recommend the discontinuation of medication.
- Be advised to document their medication consultation with clients and medicating clinicians or anyone else they may consult with (i.e., parents, etc).
In summary, non-prescribing psychotherapists can play an important role in helping clients manage their psychotropic medications. Needless to say, they should never prescribe, discontinue or change clients’ meds, unless they are licensed to prescribe. Non-prescribing psychotherapists may inform clients about treatment options, including medications, and consult with the medicating physician as clinically necessary.
Preston, J., & Ebert, B. (1999). Psychologists’ role in the discussion of psychotropic medication with clients: Legal and ethical considerations. California Psychologist, October, 32, 34.