Why are Some Talk Therapists Anti-Medication?

[ILADVOCATE]

I'm actually posting this for a family member. They are ready to approach the idea of taking psychiatric medication. Their talk therapist has tentatively diagnosed them with cyclothymia. The problem is when I speak to them about the idea of seeing a psychiatrist (again there are valid reasons why they might need medication such as continual agitatated mixed states) they say their "therapist is seeing whether they can do without medication". The therapist is not "anti-medication". They do know some people need medication but to quote my psychiatrist "a talk therapist cannot make a diagnosis". He himself is upset. If a psychiatrist said this person didn't need medication then that's fine. But most probably they do and the talk therapist keeps talking them out of it. I had the same issue as a kid with a social worker. He should have referred me to a psychiatrist early on. I have nothing against talk therapists. Some are very helpful. But talk therapy IN ADDITION to medication is usually what's needed. Why do some talk therapists think they can stand in the way of a psychiatrist when they know what's going on isn't everyday issues but psychiatric. Its hard to cope with the family member's extreme mood swings but what upsets me more is their talk therapist, although otherwise very helpful, seems to actively discouraging them from seeking psychiatric help. What can be done about this?

[bernie40]

I can sense your sheer frustration here and completely understand it.  Until your relative makes the decision themselves to seek psychiatric help, there is little you can do (which is the frustrating part) and if he is not a high risk to himself or others then neither his therapist nor anyone else can take the decision for him.  Sorry I'm telling you things that I know you already know :(

I don't know why someone would want to feel this way but I do understand that for some people they fear change of any sort regardless of whether or not it would be beneficial.  If they have been in denial for a long time then it is unlikely that they will have any sudden moment of clarification.

I think you are doing as much as you are able to do.

[ILADVOCATE]

Yes of course the family member is still approaching the idea of treatment and at this point its up to them. And I would not be able to approach the therapist because of confidentiality reasons. But the therapist should be encouraging not discouraging them to seek treatment. I tend to believe the therapist is either discouraging them or taking a neutral stance. But the therapist is working with them on it. They said that "the therapist works with them on mood issues". Its difficult despite being documented as recovered to talk down someone who also has a psychiatric disability especially if they are untreated. I know well they monitored how I was doing before recovery and it was appropriate because I did get psychotic. And what they are going through hasn't increased. I just wasn't aware of what it was. Now we both know. I explained to them that they've reached a goal of recovery "when they can tell the difference between anger and an agitated mixed state because the first is a normal human emotion and the second isn't healthy". They finally said "I'll have to learn to control myself" and I said "I'm not sure. Often these kinds of emotional states in bipolar need treatment".
  There is far less antagonism now and I am supportive of them. But shouldn't they be having this conversation (such as I mentioned) with a psychiatrist? A therapist isn't clinically trained with medical knowledge/psychiatric knowledge. The psychiatrist and therapist can work together. And I should be out of the picture. But intermittment explosive episodes directed at me are not something I can avoid. And I can talk the person down. But it would be better for both of us if it didn't happen. It took a while for them to accept I was recovered. A lot of people had this problem as its not common. But it took them longer to realize that a lot of went on in the past was due to mood episodes of their own. I do understand medication side effects and people's concerns but I can't understand a person wanting to feel this way.

[Delusion]

I wouldnt worry he or she can get medication simply by going to another therapist, you Americans have it easy they give out pills like their smarties lol

[bernie40]

I may be wrong but it seems as if the family member themselves is not ready to admit to needing a psychiatrist.  You only have the word of your relative that the Therapist is saying these things.  If this person is frightened of going to the next step of seeking a psychiatrist then they will justify this to themselves by hearing what they want to hear and not necessarily what is being said to them.

The conversation could have gone something like this:

Therapist: "You may have cylothymia"
Relative:  "I don't want to take medicine"
Therapist: "Ok, well we can see how you get on with therapy alone for now"
Relative: "Yes I'd prefer that because I don't want to see a psychiatrist"

The Therapist may well be monitoring this situation with a view to trying to persuade your relative to seek psychiatric help, again.  Or the Therapist may have already suggested that they seek psychiatric help but your relative refused.

You need to be careful about making a rash judgement about his Therapist - as I said earlier, unless you were in the room when the consultation took place you do not really know what conversation has transpired.

Just another take on this :)

[monkeyc]

Some talk therapists have an inflated sense of self importance and others have an inferiority complex because they could no get into medicine and had to do psych or (insert other therapy here depending on country).

It also depends on what sort of therapist they are - it seems to an outsider that in the US all you need is a photocopier and a print shop and you can hang out a sign as a therapist - its somewhat harder in other countries and no qualified psychologist should be reccomending this sort ot action.

I always say the same thing - if anyone other than your psychiatrist tells you to stop taking medication they do not have your best interests at heart.  Doctors are not supposed to push their personal belief systems onto their patients and yet they seem to every day, and therapists are not doctors.

The reality is that you also need to consider money - these therapists know that the patient will be coming to them less often and thus they make less money once the patient starts seeing a psych - they have a vested interest in stringing it out.  My advice is find out if this guy is registered and make a complaint - you can only act on individual cases and lets not forget there are still psychiatrists out there clinging to out moded educations and drugs who are even judgemental on patients - they get away with it as well.