My Son’s Therapist Won’t Even Discuss the Use of Medicines with Me

Reader’s Question

My 15-year-old son has been seeing a therapist 3-4 times a month for about 8 months. The counselor now believes he needs anti-anxiety medication. She believes that it will allow him to relax enough to sort through the changes he needs to make and to deal with his social issues.

In my discussions with the counselor, I asked how many of her patients she puts on medication to help the process. I only wanted to know a percentage, because if she puts the majority of her patients on medication, that might indicate she favors medication as the primary therapy tool. To my surprise, this counselor would not even discuss the issue. I did not pose my question as a matter of whether or not my son should continue going to the therapist. I just wanted to get a fair idea about her basic approach. Was my question an unfair one to ask? Am I off-base at all to have any concerns about the use of medications in a teenager?

Our Clinical Psychologist’s Reply

Of course it’s not possible to make a definitive analysis of your situation without all the facts. But you raise some very interesting issues about which I can safely comment.

Firstly, the use of psychoactive medications in children and adolescents is always a delicate business, and because you are the child’s guardian you have not only a right but a duty to be briefed on any and all recommendations for medication, the potential dangers and side effects of their use, and the relative costs and benefits. Getting a feel for the therapist’s orientation and approach to solving problems is also something you have every right to consider. Now, in fairness, several things can be possible here that might be influencing the therapist to be a bit adamant on the issue of medication. It’s possible, for example, that sufficient time and assessment has made it clear that other methods of overcoming depression and/or anxiety have not been sufficiently fruitful. It also could be possible that medication might be seen as a way of helping an overly stressed teenager “get over the hump” of a bad situation so that in the future, as they gain coping skill, they can handle things without medication. It’s also possible that environmental stressors have worsened and/or coping skills have deteriorated to the point that medication is now seen as necessary. Finally, it’s possible that the therapist has determined that a biochemical imbalance is the primary culprit in your son’s difficulties that no amount of non-medical intervention can correct.

Regardless of what factors might be influencing her desire to use medication, however, there is no reason that the therapist shouldn’t be willing not only to discuss her rationale for treatment but also to be open about her general orientation to treatment and how she views the relative roles of chemical and non-chemical interventions. Even if the therapist is relatively unskilled in non-chemical intervention strategies and operates more on the medical model, and even if you’re not fully comfortable with chemical versus non-chemical approaches, you might still want to support her approach if there is a solid rationale for it and if your son has formed a solid therapeutic rapport with this therapist and is getting the help he needs to overcome his difficulties.

Asking the question about percentages might have been interpreted by the therapist as a challenge to her approach. But even if she was being “defensive” with you because she sensed the possibility you might prematurely (and with adverse consequences to your son) “pull the plug” on therapy because of a bias you might have against the use of medication, she is obliged to share those concerns with you openly and directly.

From what you’ve said, your concern centers more around the therapist’s refusal to discuss some matters with you as opposed to pure concern over the appropriateness of her approach. You ask if your request to her was unfair and if your concerns are inappropriate. The answer to both of those questions is “no.”