It’s Not Medication v. Psychotherapy

An important disclaimer: The only type of mental health specialist who prescribes medication is a psychiatrist. As an MFT, I am very familiar with most psychoactive medications and I work with clients and their doctors to help evaluate the efficacy of their medication.

My approach when considering medication is that is always up to my clients. They can ask me if I think medication will help them, and we talk about some of effects that they hope it could have on their lives before they consult their doctor. Sometimes I am very emphatic about recommending medication after a client has exhausted all of the other options, but it is still up to them.

Are Your Medications Working Against You?

In the past I’ve also had clients who came in with medicines that were working against each other. For example, a client was seeking treatment for depression and was already on Prozac, but had neglected to note that the side effect of a different medicine – one taken for heartburn — was in fact mild depression. Using psychotherapy to ease the stress that was causing heartburn meant that the client was able to eliminate both medications and become free of depression and heartburn. Neat!

I notice two opposite unhealthy ideologies when it comes to medication:

  1. Those who are resistant to trying medication and see it as a method of weakness
  2. Those who would rather skip the investment of therapy and “just take a pill.”

Using these two ideologies, I’d like to address some common statements about medication:

“I’m Not A Fan of Medication”

I love this one. Uh…who is a fan of medication? This person usually has that admirable work ethic and has been taught to “pull themselves up by their bootstraps” and that willpower and time is the answer. (Ironically, some of these people are already medicating themselves with food, spending, or substances.)

Don’t get me wrong; I love the bootstraps and willpower. I am constantly impressed by them and trying to help my clients harness them. But chemotherapy is medication. Advil is medication. You treat your child’s broken leg by putting it in a cast and get him glasses when he cannot see. This is also a form of medication.

Thinking that physical symptoms are ok to treat with medication and that mental symptoms are not is a notion that most of us are moving beyond.

Does taking medication mean I’m crazy or not strong enough to deal with my problems on my own?

No. Not all of us are born with a predisposition towards happiness. But it can be learned in counseling, and for some it can be “learned” chemically in our brains through proper use of medication.

If you have not personally felt or seen the desperation of anxiety, the cave of depression, or the frustration of ADHD, then you can probably not appreciate the savior that medication can be to some clients.

Will I have to be on it forever?

The short answer for most of us is No. Here’s why:

  • Many conditions that are helped with medication are situational, and therefore temporary
  • Cognitive therapy is proven to be as effective as medication alone, especially if you are a diligent student
  • The brain has extraordinary healing powers and can “learn” from medication in order to make continued use of it unnecessary.
  • You get to decide what you want to do about medication, and when to go off it.

Some conditions, such as bipolar disorder, involve lifetime management through medication. For these clients, the alternative is not an option, much like any chronic physical condition.

Remember, some issues are NOT a situation of mind over matter. Some people simply just feel better with their medication and choose to make it a part of their lifestyle like their daily run or morning coffee.

Can’t I just take a pill? Counseling is so expensive.

Honestly, I really don’t understand the desire to band-aid any problem instead of dealing with it at some point once and for all. Effective treatment of most presenting problems requires commitment to do therapy and if needed, medication. But to be fair, it isn’t always the right time to go to counseling.

If this seems too time consuming, then you must really level with yourself: when is your well being going to be important enough to you to make time to address it?

Doctors should be hesitant to prescribe medication without psychotherapy. It is sketchy to send someone off with psychoactive pills and not have them work with a mental health professional to evaluate the effects!

Medication without counseling is like an athlete getting cortisone shot without seeing a physical therapist: You do the therapy FIRST, and then if the pain persists and surgery isn’t an option at the time, you get the shot. You want to know why you need the pain management, and it’s a short-term fix.

Like most things in life, the decision to try medication is a big one and should not be a made casually or alone. Please find a knowledgeable doctor and a trustworthy therapist who share your goals.