Some of the considerations that I use in prescribing
include:
1. A Strong Therapeutic Alliance helps. I work to help this develop primarily by providing
a environment where a client is able to feel safer with both me and the issues with
which they are struggling.
As part of this:
- A
safe and comfortable office setting and psychological space helps lower anxiety
and promote better sharing of information
- Less
anxiety in room also makes for much better informed consent discussions
- Short
and long term compliance in treatment is improved
- Life-long
effects of being better able to return to treatment if treatment interrupted
- And
most importantly, nothing happens in treatment unless the client and clinician
both think that it is a good idea
2. Use
of the Stahl Model for prescribing psychiatric medications.
- Use
expanded assessment model and not one limited to DSM-IV-TR criteria
- Explore
possible medications to maximize number of potential positive changes (for
example, mood and focus vs. mood alone)
- Explore
medication options with regard to minimize risk of side effects (previous
history and current known physical issues as well as expanded assessment model
help make better choices for medications that are lower risk for that client)
- Most
clients can be treated with medications that are less likely to cause sedation,
weight gain, or sexual side effects
- Treat
short term side effects as necessary (first 6 weeks of medications)
- If
the medication is effective and has long term side effects (longer than 6
weeks) then these unwanted effects can usually be effectively treated
3. Search
for optimum treatment.
- Facilitate
the client exploring “the next right thing to do”
- Facilitate
the client actualizing “the next right thing to do”
- Always
work with what the client wants for themselves
4. Safety.
- Require
that the client be actively treated with psychotherapy (almost always another clinician)
- Monitor
physical issues closely
- Actively
collaborate with other clinicians treating the client
- Normalize
and walk through the clients safety plan, including exploring their resistances
to using parts of it and generate with the client ways that will help them
remember why it is important to ask for help
I am looking forward to speaking with you.
Ellen Tucker MS, PC, NP
