Attitudes and Beliefs of Marriage and Family Therapists regarding Psychotropic Drugs and Therapy
Springer, Paul R., Harris, Steven M., Journal of Marital and Family Therapy
Clinical members of AAMFT were solicited by means of a randomized multi-staged clustering technique to identify their attitudes and beliefs regarding psychotropic drugs. All participants were blind to the overall purpose of the study (n = 322) and were directed to read a clinical vignette and then identify what course of action they would take with the client. They were then asked to complete a small questionnaire regarding their attitudes and beliefs regarding psychotropic drugs. Results of the study showed that 35.7% of the clinicians identified medication and a medication referral as a viable treatment option they might pursue with a client meeting criteria for major depressive episode. Clinicians who reported having a dedicated university class (17.2%) in psychopharmacology were more likely to identify medication referral as a treatment option. However, 80% of the AAMFT clinicians we surveyed reported that they were not adequately trained about psychotropic medications in their graduate programs. Further implications regarding diagnostic practices are also discussed, as 26% of clinicians failed to explicitly diagnose the client in the case vignette with depression.
In 2005, Hernandez and Doherty addressed the practice patterns of marriage and family therapists (MFTs) whose clients use psychotropic medication. In this study they found that 91% of all MFTs work with clients who are on some sort of psychotropic medication, and who account for nearly a quarter of their caseload. These findings are important in light of the ambiguity in the MFT field surrounding medication as a therapeutic adjunct. In fact, it suggests that despite past negative beliefs and attitudes about psychopharmacology (Jackson, 1967; Patterson & Magulac, 1994), MFTs do work with patients who receive psychotropic medication. However, little, if any, research examines MFTs' attitudes and beliefs in working with medicated clients. In fact, it is unknown what role MFTs take in collaborating with physicians regarding medication referrals, or even under what circumstances MFTs deem medical consultations to be appropriate (Hernandez & Doherty, 2005).
Historically, some of our founding theorists expressed negative feelings about the appropriateness of medication (Haley, 1989; Jackson, 1967; Markowitz, 1991; Patterson & Magulac, 1994). As a result, marriage and family therapy, as a discipline, has yet to reach a consensus regarding this topic (Hernandez & Doherty, 2005). Even with the advent of newer and safer psychotropic drugs, as well as the emergence of strong research supporting the effectiveness of combined treatment approaches (Beitman, Blinder, Thase, Riba, & Safer, 2003; Beitman & Saveanu, 2005; Friedman et al., 2004; Jindal & Thase, 2003), family therapists seem ambivalent about how helpful medication may be in therapy. In fact, Pinsof and Wynne (1995) provided compelling results in their study that MFT approaches alone are insufficient to treat various mental illnesses. Consequently, MFTs may need to look outside their theories and be willing to look at non-MFT treatments to effectively provide optimal care for their clients.
Compelling research on schizophrenia and bipolar disorders (McFarlane, Dixon, Lukens, & Lucksted, 2003; Miklowitz & Goldstein, 1997) has further established the benefits of developing treatment approaches that are traditionally outside of MFT approaches. These approaches implemented in the schizophrenia and bipolar research still maintain a family-based model, but they are able to effectively develop a collaborative and shared treatment approach while integrating medication and psychoeducation in a complementary way. Results of the schizophrenia and bipolar studies have shown that shared treatment approaches considerably lower relapse rates when family psychoeducation and medication interventions are promoted jointly, when compared to either individual therapy or medication alone (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998; Miklowitz et al. …