MARRIAGE AND FAMILY THERAPISTS AND PSYCHOTROPIC MEDICATIONS: PRACTICE PATTERNS FROM A NATIONAL STUDY

Journal of Marital and Family Therapy, Jul 2005 by Hernandez, Barbara Couden, Doherty, William J

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n = 283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n = 375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.

In 2001, the American Association for Marriage and Family Therapy (AAMFT) guideline revisions for curricula of accredited therapist education programs added psychopharmacology as a required domain. According to the national survey of marriage and family therapist (MFT) practice patterns conducted by Doherty and Simmons (1996), almost 30% of MFT clients used psychotropics. However, there is very little research about how MFTs actually work with clients whose physician or psychiatrist has already prescribed medications for them (Mueser, 2003; Wehrenberg, 2003). Marriage and family therapist effectiveness with such clients has, until recently, been relatively neglected. In the only study addressing the role of psychotropics in MFT practice to date, Trudeau, Russell, de la Mora, and Schmitz (2001) found that clients of MFTs were significantly less likely to use psychotropics than clients of social workers and psychiatrists, but treatment effectiveness was not addressed.

Marriage and family therapy as a discipline has not yet reached a consensus regarding the use of psychotropics as a therapeutic adjunct. Debate about the appropriateness of psychotropic use has been a salient theme from the beginnings of family therapy (Jackson, 1967; Palazzoli, Boscolo, Cecchin, & Prata, 1982; Patterson & Magulac, 1994) to the present time (Horak, 2003; Lawson & Lawson, 2003; Sparks, 2002). According to pioneers in the field, symptom etiology was relational in nature, implicating such elements as parenting practices (Bloch & Simon, 1982; Lidz, 1963), differentiation (Kerr & Bowen, 1988), or homeostatic processes of whole families (Haley, 1984; Keith & Whitaker, 1980). Currently, some clinicians question the long term usefulness of psychotropics (Duncan, Miller, & Sparks, 2003; Keith 2003). Lebow's (2004) review of serotonin reuptake inhibitors (SSRIs) efficacy studies revealed that SSRIs are not more effective than older tricyclics, and they offer minimal relief of depression symptoms in children and adolescents, while increasing the risk of suicide. However, there have always been clinicians who have addressed genetic and biochemical aspects of mental illness, many of which can be positively affected by psychotropics (Kaslow, 1982; Marsh, 2001; Resnikoff, 2001; Wynne, Shields, & Sirkin, 1992). Pinsof and Wynne (1995) reported that MFT approaches alone are insufficient to treat a number of serious mental illnesses and that collaboration with other mental health professionals and the use of non-MFT treatments are required. Numerous studies exist in which independent variables include such concepts as expressed emotion, communication deviance, and affective style in schizophrenia and bipolar illness (McFarlane & Lukens, 1994). Likewise, there are numerous studies in which medication compliance (McFarlane, Dushay, Stastny, Deakins, & Link, 1996), relapse and hospitalization (Rea, Strachan, Goldstein, Falloon, & Hwant, 1991; Tarrier, Barrowclough, Porceddu, & Fitzpatrick, 1994), and medication dosages (Schooler et al, 1997) are dependent variables. These new emphases on biopsychosocial components of serious mental disorders have resulted in the inclusion of family education, psychotropic regimens, community resource allocation, and active problem-solving in treatment (McFarlane & Lukens, 1994).

The development of medications with fewer side effects, a market driven by aggressive advertisement, and mental health practitioners trying to conform to organized medicine demands increase the likelihood that MFTs will treat individuals using psychotropics. Clearly, psychotropic use is a growing reality for MFTs and standards of practice are needed to develop appropriate and safe client treatment.

The overall goal of this study was to establish what is known about current practices of MFTs who work with medicated individuals and to increase our understanding of how MFTs manage the treatment of such clients. The study addressed four research questions about MFT practice patterns and clinical effectiveness when treating clients taking psychotropics:

1. What are the demographic and background characteristics of MFTs' clients who are taking psychotropics, and how do they differ from clients who do not use psychotropics?