|
Psychotherapy,
Medication, & Teens
Thomas
E. Carter, M.I.T., Ph.D.
Headmaster/Behavioral Therapist
Shamrock Educational
Academy
Newman Lake, Washington
(509) 226-3662
The two different
arenas of psychotherapy and medication go hand in hand
when treatment involves the behavior and overall mental
well being of teens. It is astounding to see how many people
today are led to believe that medication alone will heal
the wounds of psychiatric problems that are affecting their
teens. This is totally inaccurate and a myth.
The latest studies
by the American Academy of Child & Adolescent
Psychiatry have recommended that medication can
be an effective part of treatment when used as part of
a comprehensive treatment plan that includes psychotherapy.
Without psychotherapy treatment, medications can effectively
mask the problem by erecting a medication wall to make
the undesired act or behavior go away. Let’s just take
for granted that the undesired act or behavior does go
away; then ask yourself, what happens when the medication
is stopped? The answer is that the undesirable issue will
still be just as present and active as it was when the
medication was started.
I am NOT advocating
abandoning the use of all psychotropic medications when
treating teens. Instead, I suggest taking the next step
in the treatment process: work on the undesired act or
behavior in conjunction with the use of medication. Then
the teen can learn how to deal with the problem even if
the medication is stopped.
A recent study
published in the Archives of General Psychiatry indicated
that carefully managed medication results in a better response
from children diagnosed with ADHD than therapy alone. For
children with co-diagnoses of other behavioral issues,
therapy and medication in combination tend to work best,
and researchers found that as many as two-thirds of children
with ADHD have another behavioral issue. Therapy often
reduces the amount of medication necessary for management
of ADHD. In other words, medication and psychotherapy work
best when used together to obtain a desired norm.
Many parents
ask, “What happens if my child will only take the medication
but will not attend therapy?” In retort I ask if their
doctor prescribes one pill four times a day for an illness,
do they only take two pills a day? If we want the most
effective means of treatment wouldn’t we complete the entire
prescription? There needs to be a distinction in treating
patients with behavioral and emotional issues as compared
to treating patients with medical conditions, such as sinusitis.
Still the questions stand what should we do with the child
who does not want to participate in the therapy process.
This is where total inclusion may be the most effective
option. A treatment facility, group home setting, behavioral
institution, mental health hospital, wilderness program,
or therapeutic boarding school may be considered. Why?
If a child will not take part in the full treatment process
to help him or herself then we must ask a question: Is
this person thinking or acting in a healthy rational state
pertaining to their well-being?
I recently interviewed
a young man who was previously diagnosed with depression,
Attention Deficit Disorder (ADD), Obsessive Compulsive
Disorder (OCD), and Oppositional Defiant Disorder (ODD).
His strong resistance to a psychotherapy component is an
example of the complicated issues related to approaching
psychiatric treatment through medication alone. This young
man was admitted to a hospital psychiatric ward at age
thirteen, followed by a path that resembled a ping-pong
game. He worked with therapists, went to outpatient therapy
at a behavioral health center, followed by another admittance
into an inpatient psychiatric ward. Then he went to a wilderness
program, followed by a therapeutic boarding school, returned
as an inpatient client at a behavioral health center, was
sent back to wilderness, followed by a return to a boarding
school, back to the behavioral health center, and lastly
to another therapeutic boarding school where he finally
addressed his issues and behavior with a developing sense
of honesty and maturity.
When asked what
made the last placement work, this seventeen-year-old male
stated: “First, I felt that this would be my last chance
for some reason. At that point I decided that I had to
stop getting kicked out of places. Next, the last place
was more of a family environment that dealt with real issues
and real time that was not removed from the real world.
I also felt that the games were not present, and the therapist
in-charge was upfront and honest, telling me where I was
and what was expected of me. Lastly, this was a chance
for me to participate with the real world again, the world
that I was taken away from at thirteen. Once proving myself,
I was able to participate in sports and interact with appropriate
people outside of the program. Now I’m in a place where
I feel I have come a long way. I have been accepted into
colleges and I also have a very clear understanding of
how my future will play out in a healthy manner with the
tools I have learned along the way. And, I have a greater
respect for my family, others, and myself. Before that
I had a nonexistent type of relationship with my family
and now I feel I have a warm relationship with them.”
While considering
this miraculous turn around of a young man’s life, it is
important to resist the temptation to give all the credit
to the last program that this young man attended. We have
to look at what he learned along the path he traveled for
so many years, before he decided to listen to and use the
information that he had received from the numerous professionals
he had encountered. This learning process, in combination
with the connection and investment he made with the therapist
and the program in his last placement, created an opportunity
for him to mature emotionally. This is an example of a
family that was committed to helping their child and to
doing what was in their child’s best interest, no matter
how much they had to sacrifice emotionally, physically,
and financially.
Some people feel
their child will never find help without medication. Yet,
there are no silver bullets with medication. It may be
necessary, but should always be used in conjunction with
therapy, thus completing the whole therapeutic process.
Important
Considerations When Your Child is Taking Medication:
- Adults
should always supervise children's medication. I have
worked with many parents who assume that their child
should be
responsible for taking their own medication, which
results in missed dosages, over dosages, or not taking
the medication
at all. The medication must be taken as prescribed
for it to be effective.
- Ask
whether your child can take over-the-counter medication,
if needed for a cold, upset stomach, cough, fever, etc.
- Ask
your physician what kind of behavior to expect from your
child when medicated: short term and long term side effects
to watch for, and who to call if there are any problems
related to medication.
- Find
out what time of day should your child take his/her medications,
and whether it should be taken before eating, with, or
after meals.
- What
foods, drinks, and activities should be avoided while
using medication?
- Do not
self prescribe for yourself or others unless you are
a medical doctor. Medications should only be given to
the
person it was prescribed for, and no one should take
any other person’s medication.
- Always
lock up your child's medication in a location where other
children in your family cannot have access.
- Children
should have professional and family support while on
medication.
- Inform
your doctor of any other medication your child is receiving
from other doctors. Also inform the doctor of any allergic
reactions to medications.
- If your
child needs to take medication during school hours, inform
the school nurse and ask your doctor to sign a permission
slip to give the medication at school.
- Your
child needs to be monitored regularly by your doctor
while on medication regarding its use, possible adjustments
in
dose and need for blood tests and other tests.
- Adolescents
should be educated about the medication by experts.
- If medication
is going to be given by babysitters, relatives or friends
while you are out of town, give written instructions
about the time of day to give medications, side effects
to look
for and your doctor's phone number for emergencies.
Considerations
When Finding a Therapist for Your Child:
- It
is generally a good idea to talk with more than one therapist,
counselor, or psychiatrist on the phone or in person
before making a final decision. Many will offer a free
initial consultation.
Go into the consultation with a list of questions you
would like to ask and tell the therapist about your expectations.
- It is important
to choose a therapist who is a good match with you and
your child.
- Make sure
your therapist or mental health care provider is licensed
to
practice in your state or country.
- Check with
your insurance company to see which providers are covered
under
your plan.
- Ask about
areas of expertise, additional training or certifications.
It is important
to recognize that not every teen experiencing emotional
or behavioral problems requires medication as a part of
their treatment plan. It is often a difficult task for
a parent to determine if medication is needed, and many
people have preconceived ideas about the use of medication
to treat emotional or behavioral problems. As a parent
or guardian of a teen, it is vital to approach this issue
with an open mind. It is necessary to ask questions, analyze
information and have the courage to pursue a second professional
opinion if unsure of the treatment recommendations. Then
you can be invested in the decisions made during the treatment
process. If medication is a part of your teen’s treatment,
it is important to remember that psychotherapy and medication
go hand in hand. There are no quick fixes. The only true
answer lies within the completion of the whole process.
We must investigate and pursue all avenues to ensure the
safety and survival of our children no matter how strenuous
the process might be.
______________________
Psychiatric Medication
for Children and Adolescents Part 1: How Medications are
Used, American Academy of Child and Adolescent Psychiatry,
11/1999, No. 21.
A 14-Month Randomized
Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity
Disorder, Archives of General Psychiatry, 1999, Issue 56,
pp. 1078-1086.
|
