Tips for Effective Conversations About Medications

Non-prescribers can play an important role in patients' medication experience.

Reviewed by Monica Vilhauer Ph.D.

Key points

• Therapists might feel its unethical to talk in detail about medications because they're not prescribers.
• Therapists see patients more than prescribers and may be the fist line of defense against discontinuation.
• Talking to patients about medications can be simple, and is ethical, so long as no medication advice is given.

Helping professionals ask a lot of questions. Depending on one’s role, questions might be tuned to more closed ended (e.g., yes/no answers) or more open-ended (generating more detailed answer) inquiries.

One topic that might seem sufficient to receive yes/no answers for if you’re not a prescriber is medications. In many records from non-prescribers that I review, it seems medication has only been addressed with, “Are you on medications?” “What are they?” and “Do you take them?” Ostensibly, it might seem sufficient for general purposes. Asking more detailed questions about people’s experiences with medications, however, can be a richer source of information than initially meets the eye.

I’ve found two things that contribute to the dead-end questioning. First, many organizations or institutions utilize a form simply requiring boxes to be checked about medication. Second, some supervisees have confessed they avoid medications conversations because they're not a prescriber and its not their role. They feel they're edging out of their scope of practice and opening themselves to ethics violations.

Why we should ask more

Taking a second look, consider that many patients are on prescription medications, psychiatric or otherwise, and its only proper they're asked about in detail; they could be contributing to the presenting problem. To continue, if someone is taking the medication as prescribed, that is not a prompt to change topics. Medication compliance might be the issue. Maybe they're compliant and it alleviates depression, but it causes hypersomnia, making it hard to awaken, and truancy follows.

Further, depending on the prescription and how long they've taken it, they may have withdrawals when going off of it that are exacerbating things. One can even experience unpleasant withdrawals from antidepressants, especially Paxil and Effexor (Harvard, 2022). Also, if someone was on effective medications, then discontinued because their symptoms subsided, symptoms may rebound quickly once unmedicated — especially after using antipsychotics and mood stabilizers. With these scenarios in mind, non-prescribers may be thought of as gatekeepers of sorts, and it might actually be considered unethical not to review medication in more detail.

We're not prescribers, but the patients might nonetheless need our guidance. As I discuss in my book, Getting Started as a Therapist: 50+ Tips for Clinical Effectiveness (Routledge, 2024), talking to patients about their medications, and how to approach various scenarios, can be vital to patients' improvement. Asking, for instance, about side effects and how they're effecting the person led to one man saying if the doctor felt he should be on it, it must be correct, regardless of discomfort. He didn't know he could reach out to doctors in between appointments, and wasn't sure what to say.

While anyone other than prescribers or pharmacists shouldn't be giving medication directives, with the above in mind, we'd be remiss in not talking in detail about the medication experience. For one, therapists generally meet with patients more than prescribers. Therefore, therapists could be extremely important in gauging if the medications are effective or, more importantly, problematic, and in the case of the latter, encouraging/helping them coordinate contact with the prescriber.

How to ask more

To have brief, but thorough conversations about medications, think of the initial question as a prompt for a conversation about it and be ready with follow-up questions (below). In addition, consider phrasing the initial inquiry as, “Are you prescribed any medications?” instead of “Are you on any medications?” While this might seem to be splitting hairs, people may be prescribed medications but are not taking them, thus considering themselves not on them, and answer accordingly. Follow-up questions include:

1. "Do you take them as prescribed?” Even if someone answers “yes,” its helpful to ask if they ever miss doses. Their definition of “taking as prescribed” could be loose. If they report missing doses, find out how often this happens and if they/their guardian notices an effect.
2. If they confirm taking it as prescribed, “Do you find them helpful?” will ideally follow. But don’t stop here! If helpful, how so? What positive changes occurred? To be extra thorough, ask if, despite the improvements, have there been any unpleasant effects, like in the example of poor sleep, above? If annoying side effects are sufficient, despite some improvements, some might contemplate discontinuance, which then warrants a referral to their prescriber. Oftentimes dose adjustments or an augmenting medication can combat those side effects.
3. Should someone say they are not taking them or are missing doses, its of course important to discover why. Chances are, it is more complicated than someone simply wanting to be oppositional. Thus, asking, “Why do you not take them as prescribed?” or “What leads to missing some doses?” is helpful.

It is sometimes easy to fall into the trap of wondering why someone can’t simply follow through with taking medications. Recognize, however, that it could be side effects, insurance issues, forgetfulness amidst navigating everything else in their chaotic lives, self-medicating, or the prescription ran out and for some reason they’ve not had contact with their prescriber or moved and don’t have a new one. All of the above can contribute to their presenting problem.

To illustrate, imagine a kid with, say, depression, who experiences more irritability than sadness. Then, consider they were historically on an antidepressant that curbed the irritability, but they’ve been unable to get it. Being chronically irritable is frustrating, and irritability lends itself to aggression. Sufficiently frustrated, it is no surprise that the irritability might easily become unleashed, leading to school/home/community-related consequences.

Lastly, remaining curious about their experience can help even more. For example, if a kid says they take ADHD medication but it makes them feel agitated, asking, “Describe that for me” can be revealing. Maybe this is correlated to an uptick in impulsive behaviors at school. If they aren’t currently taking a medication, finding out if they would like to and if they need help finding a new prescriber might accelerate progress.

Clearly, therapists can safely navigate questions about medications without “playing doctor.” We're not prescribers, but our clientele may nonetheless need our guidance about navigating some aspects of medications.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual's provider or formal supervision if you're a practitioner or student.