Dear Therapist:

My wife has been diagnosed with anxiety and depression. She has been seeing a therapist who has been treating her using cognitive behavioral therapy. She has not made that much improvement and our family doctor suggested she see a psychiatrist. The psychiatrist is recommending that she take medication to help with this. However, her therapist is strongly discouraging taking medication and is adamant that she has the strength within herself to get through this without medication. This leaves us in a dilemma where two trusted professionals are giving strong contradictory opinions. This in itself is increasing our stress in dealing with this. I would appreciate the panel’s advice on this confusing matter.

Response:

Your question represents two perspectives—that of your wife’s therapist and that of the psychiatrist. There is, however, another perspective, namely your wife’s. Although both the therapist’s and the psychiatrist’s concerns should be taken into account, I wonder what your wife’s feelings are about the idea of taking medication.

Clients are sometimes concerned about hurting their therapists’ feelings, or of damaging the therapeutic relationship by disagreeing with their therapists. If this is a concern, it should be brought up in therapy. Professionals should not be insulted by anything that a client throws at them. If your wife is not comfortable with her therapist’s stance, this should be dealt with in one way or another.

I assume that your wife has been seeing her therapist for some time, and that the therapist has a good sense of your wife’s issues and of her strengths and weaknesses. That being said, her therapist is not in your wife’s shoes, and should not be making decisions for her. More specifically, medication is not within a therapist’s expertise. Technically, decisions about medication, although discussed with the therapist, should not be made based on the therapist’s beliefs.

However, it sounds as if your wife saw the psychiatrist only once, and this likely prior to hearing her therapist’s thoughts on medication. If your wife is not entirely comfortable with the psychiatrist’s opinion, she should meet with him again (or speak with him over the phone) to discuss her concerns. It would be a good idea for your wife to ask her therapist and the psychiatrist to discuss their points of view. This way they could each understand the other’s perspective, perhaps coming to a mutual conclusion.

Even if the therapist is correct about your wife’s ability to decrease her anxiety and depression without the use of medication, this does not necessarily preclude the use of medication. Both anxiety and depression can hamper a person’s ability to effectively use the tools necessary to help them. Medication can help a person to reduce his symptoms to the point at which he can better employ the tools learned in therapy. Often, medication is at this point reduced or eliminated. This can lead to faster recovery and to better outcomes. 

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317