What Nonmedical Therapists Should Know About Adverse Drug Effects
Although prescribers often have difficulty discerning the etiology of physical complaints, differentiating their probable associations with treatment versus underlying illness, and recognizing the necessity (or nonnecessity) of interventions, such challenges can be even more daunting for nonmedical psychotherapists. The potential advantages and disadvantages of so-called split or collaborative treatments between two clinicians involve broad issues that fall beyond the scope of this book (but are well addressed by Riba and Balon ; cf. Kelly  on the concept of “parallel” treatments as independent endeavors). However, because nonmedical therapists have a positive role to play as a member of a treatment team, we offer the following cautionary considerations that bear on the assessment of adverse drug effects:
Nonmedical therapists may not recognize which physical complaints are or are not plausibly iatrogenic and could erroneously reinforce patients’ misattributions about etiology.
Patients who erratically take sedative-hypnotics or opiates or binge on alcohol might describe withdrawal phenomena that could be misconstrued as psychological or psychiatric rather than physical; similarly, patients who abuse controlled substances may complain of symptoms that could be misinterpreted as medication side effects (or primary psychiatric symptoms) that actually reflect intoxication, withdrawal, or neurotoxic states.
Nonmedical therapists may sometimes unwittingly overstep scope-of-practice boundaries through well-intended but potentially medically inaccurate suggestions about ways to manage adverse effects (e.g., advising a patient to alter the dosage of a medicine, proposing a pharmacological remedy for an adverse effect, or wrongly encouraging patients to “wait out” a serious side effect that they assume will ultimately resolve with time—rather than advising a patient to redirect medication concerns to the prescriber).
Nonmedical therapists may be unaware of the medical significance of a probable adverse drug effect when addressing physical symptoms that might also have a psychodynamic or behavioral etiology. For example, the therapist may examine loss of libido or sexual dysfunction solely in the context of past conflictual or traumatic intimate relationships, or may perceive complaints of anxiety and restlessness as manifestations of psychic distress surrounding the material under scrutiny in psychotherapy (rather than, perhaps, as manifestations of akathisia or pharmacologically induced psychomotor activation).