Therapeutic Implications of Pharmacotherapy: Current Trends and Ethical Issues

Article excerpt

During the course of a year, about 1 in 5 Americans experiences a mental health disorder, and about 10% of the U.S. adult population use mental health services during that year (Satcher, 2000). Concurrently, the influence of managed care has increased the number of professional counselors providing mental health services in conjunction with a prescribing physician (Comer, 2002; Imhof, Altman, & Katz, 1998; Meyer & Simon, 1999b). As such, patterns of psychotropic medication use (pharmacotherapy) have changed dramatically. Zito et al. (2003) analyzed community treatment data on children and adolescents to ascertain psychotropic drug use patterns from 1987 to 1996. During the decade studied, psychotropic medication usage increased to 6% of youth, representing a two- to threefold increase. Julien (2001) commented that with the popular addition of antimanic and new generation antipsychotic prescriptions, psychotropic medication use among children and adolescents would continue to increase dramatically.

Among older adults, Keltner and Folks (2001) observed that psychotropic medications are the second most commonly prescribed class of medications for alleviating symptoms of mood disorders and psychotic disorders. In addition, they noted that with a decline in the death rate and an increase in longevity, the growth rate among older adults--especially those older than 85--will be many times greater than that of adolescents; hence, prescriptions for psychotropic medication are also likely to increase in this population. Indeed, the spectrum and prevalence of psychotropic medication use across the life span is significant and finds its way into counselors' everyday practice.

NEED FOR COUNSELOR KNOWLEDGE OF PSYCHOPHARMACOLOGY

Assessing the Status Quo

Although Buelow, Hebert, and Buelow (2000) declared "Knowledge of the use of psychiatric medications is clearly becoming a necessary step in the development of the science and art of psychotherapy" (p. 2), many counselors are not receiving adequate master's-level training in psychopharmacology. Hershenson and Berger (2001) surveyed directors of Council for Accreditation of Counseling and Related Educational Programs (CACREP)-accredited community counseling programs on their plans for changes in curricula. Although 20% of respondents planned to add one or two courses to their curricula during the next 5 years, less than 6% of respondents recommended course work in psychopharmacology.

Scovel, Christensen, and England (2002) surveyed members of the American Mental Health Counseling Association to obtain their opinions regarding mental health counselors' training needs in the field of psychopharmacology. Even though more than 90% of respondents indicated that basic education in psychopharmacology should be part of the required curricular core (so that counselors can properly refer clients to prescribing physicians for psychotropic evaluation when necessary), 81% of respondents were not required to take a course in psychopharmacology. This inverse correlation between counselor attitudes and training opportunities in psychopharmacology is cause for great concern, because 89% of respondents also reported that they work with clients who are taking psychotropic medication.

Counselors and the counseling profession would do well to consider the therapeutic implications of such a deficit in counselor training and practice. We contend that counselors cannot provide comprehensive treatment planning, ensure client well-being, and minimize professional liability without proper training in psychopharmacology. Attention, therefore, is now directed toward a discussion of these ramifications.

Enhancement of Psychotherapy Interventions

Knowledge of psychopharmacology is essential for counselors because ethical guidelines admonish them to remain current on scientific and professional information in their realm of practice (American Counseling Association [ACA], 1995, C. …