Professor Rosemary Rizq posed the following questions to us at the beginning of the talk:
She described the scale of the problem 17% of the adult population was on an antidepressant in 2017, with nearly one million people taking an anti-depressant for at least 3 years. These figures seem to continue to head in the wrong direction.
There is guidance which can be found at www.prescribeddrug.info. Its purpose is to empower therapists to discuss with clients the issues arising from taking or withdrawing from prescribed psychiatric drugs during therapy.
We were also asked to think about how our theoretical orientation, place of work, personal experience or experiences of family or friends affects the position we take as therapists towards prescribed drugs, and how this affects discussions we may have with clients. The ethical issues of informed consent and how we work with, for example, GPs or psychiatrists were also discussed.
Rosemary suggested our role with clients is sharing information from a reputable source, discussing scientific evidence and offering a different perspective e.g., on causes of psychological problems, this includes understanding the likely impact of prescribed drugs on the process and progress of therapy. Clients requiring medical advice should always be encouraged to talk to their GP or psychiatrist.
Prescribed psychiatric drugs have potential effects on thinking, feeling and behaviour. Therefore, there are important considerations for the client who is starting, or considering starting, a prescribed psychiatric drug. Equally for clients and therapists alike it’s important to understand the range of possible withdrawal reactions when coming off psychiatric drugs and to avoid misinterpreting withdrawal reactions as a return of the original problem.
Finally, we were put into small breakout groups to discuss some of the crucial issues raised in the talk.
What does the ‘medical model’ mean to us? Are there ways in which our practice has been impacted by the medical model? How would we feel about contacting our client’s GP or psychiatrist to discuss problems associated with their use of prescribed drugs? Also, what are some of the difficulties or dilemmas we have encountered when working with clients who are taking or planning to take prescribed drugs?
Overall, a fascinating and very stimulating evening presentation and discussion. The feedback afterwards was that people found the evening engaging, informative, enjoyable and definitely left us wanting more.
Rosemary began asking us to reflect on our own clients use of prescribed drugs, as she presented the figures from PHE of the numbers of people currently prescribed antidepressants (7.3 million), opioid pain medication (5.6 million), gabapentinoids (1.5 million) benzodiazepines (1.4 million) and Z drugs (sedatives) (1 million) and compared these figures to people who have been taking these medications for more than 3 years: antidepressants (930,000), opioid pain medication (540,000), gabapenttinoids (160,000) benzodiazepines (20,000) and Z drugs (sedatives) (100,000).
Looking at what counsellors and therapists need to know, she then referred to a document she had co-authored “Guidance for Psychological Therapists” and the abridged version “A short guide to what every psychological therapist should know about working with psychiatric drugs”, both available at
Rosemary suggested we should be informed, so that we can enter into discussion with our clients to support their choices, but to be clear about boundaries and ethical issues. She demonstrated her own practice using the example of one of her own anonymised clients. Rosemary then discussed the impact of withdrawal from psychiatric drugs and how withdrawal symptoms can be misinterpreted as relapse by the prescriber, resulting in medication being restarted. She empathised the important role counsellors and psychotherapists’ can take, explaining the symptoms of withdrawal to clients, to ensure they are well informed, directing them to another publication issued by the Royal College of Psychiatry stopping-antidepressant-printable.pdf (rcpsych.ac.uk)
We broke into small groups to reflect on what the medical model means to us, how it impacts our practice and whether we would be comfortable discussing problems associated with drug use, with clients and their GPs/psychiatrists. The session ended with the whole group sharing thoughts from these smaller discussions.
This was a very insightful evening talk and made me reflect on my own practice, where I sit with the medical model and with a desire to learn more.