Discussion with Ted Sundin at ORCA Conference November 2013
Ideas for counselors working with clients regarding their
medication use:
 Need alternatives if coming off meds – e.g. diet, exercise,
meditation, social support, etc. – not merely elimination of meds
 Explore client’s own experience and wisdom regarding their own
med use and its effects on client’s life
 Help educate client to get to know their own meds, dosage, and
do their own research on effects
 Teach them to do their own evaluations: PARQ
 Advise clients about considerations if getting their med
prescriptions from primary care practitioners: main primary care
knowledge of meds comes from psychopharm reps
 Highest risk seems to be from long-term use, rather than limited
use (e.g. Xanax at moments of high anxiety)
 How much of our conceptualizations of client symptomology is
based on a set of cultural beliefs, rather than science?
 Part of job may be to help educate primary care practitioners
about alternatives to meds
o Follow-through increases the more closely tied counselor is
to primary care practice – have doctors refer to counselors
 Better to refer direct to counselor, rather than giving
counselor name to client?
o Create practice improvement teams across disciplines
o Maybe start with one receptive doctor and spread from
there
o Position as what we can do to make doctor’s live easier, not
additional level of work
Discussion with Ted Sundin at ORCA Conference November 2013
 Sometimes there are seemingly arbitrary policy changes within
primary care offices that result in sudden changes for clients – e.g.
swapping or dropping med categories, or switching to CBT (based
on perception of latest risk or fad)
 Help clients learn how to advocate for themselves with their
prescriber
 We need to understand the complexities of medication
prescribing, effects, and titration, rather than having strict
pro/con attitudes
o Recognize that there is a great deal regarding med use that
none of us know
 We should strive to understand the differences between clients
and their situations and responses, rather than grouping all
together (e.g. depressed, psychotic, bipolar people)
 Primary care providers typically do not have time to do full
assessment/history/social environment, and so Tx decisions based
on very limited data
o So prescribe meds when the real problems are quite
different
 Schizophrenia studies correlate with high emotional expression
(EE) in family systems
o Lowering family EE reduces symptoms and need for meds
 No scientific basis for typical approach of prescribing multiple
meds in combination – often 6 or 7 concurrent meds: no studies
 Need to create education in collaborative multi-discipline settings
 Learning about medications for non-prescribers: NIMH website
(might be good for clients also); Taffy Clarke-Pelton in Southern
Discussion with Ted Sundin at ORCA Conference November 2013
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Oregon put together nice short class for counseling grad students;
also read Robert Whittaker (Anatomy of an Epidemic)
Daniel Amen has package for health care professions (rather than
expensive brain scans) – unsure of usefulness of approach
Recognize that psychiatry dominated by biological/medical model,
and thus openness to non-biological treatments often limited
Dan Siegel’s ‘wheel of awareness’ useful as mindfulness technique
“Every human being is a unique way to the divine” – what if we
tell clients “there’s nothing wrong with you”?
Some reactions that clients may deem as ‘negative’ when coming
off meds (e.g. crying) may be very normal reactions that have
been suppressed (often for years) through med use (as with
drugs/alcohol)
Wellness focus (rather than treatment) may be the critical longterm solution to our growing healthcare challenges
As a culture, we resist and fight aging and dying
Need to be aware of discontinuation syndrome – short-term
effects resulting from coming off meds, rather than symptoms of
underlying condition
Could there be value in depressive, anxious or psychotic
symptoms? For example, look at the creative contributions of
people with “bipolar disorder”. What if we viewed as ‘intense life
energy’? Hard to accept that in the midst of ‘madness’ there may
be brilliance.
No consistently good solutions yet for Tardive Dyskenesia from
antipsychotic meds