|INTERVIEWING TIP OF THE MONTH
# 86 April 2007
"Increasing Medication Interest Using Crutches As a Metaphor"
TISA Description of the Problem: Some people are hesitant to use medications, for they feel that they shouldn't "need" a medication. By helping them to re-frame the use of medications the clinician can often help them to bypass this hurdle to healing. In the following excellent tip, Edward Rubin, Psy.D. sheds some new light on how to approach this important task through the clever use of a metaphor. You might remember that Dr. Rubin also provided last month's Tip of the Month - the "learning to ride a bicycle metaphor."
Tip: When I discuss a psychotropic medication with a client who has never been on one before, and I find them to be reluctant, I often talk about how, if their leg was broken, it might be suggested that he or she use crutches. I then ask, "Would you feel the same way about the use of crutches as you do about the use of a medication to treat your depression." They almost always say, "No."
This inquiry and response opens the door to a more open discussion about the use of medications. I mention crutches are often time-limited in their use. They may be helpful long enough to let the ankle or bone heal or repair itself more readily. Once they are feeling better, they consult with their physician, who might say it is okay to stop using the crutches. I explain that it is no different with an antidepressant, there might come a time when they may be reduced or even stopped and this decision would be made with his or her physician. I point out that medications help the brain to heal more effectively and much faster, sometimes markedly decreasing the length of a depression or even relieving a depression that the brain itself would have trouble healing by itself. I feel that this metaphor frequently allows clients to think about the use of medications from a different perspective. Using this perspective the client may be more inclined to consider a medication trial.
TISA Follow-up: Yet another excellent tip from Edward Rubin, that may tip the scale towards trying a medication trial in a client hesitant about the use of medications. A special thanks to Dr. Rubin for two tips in a row.
Tip provided by:
Edward M. Rubin, Psy.D.
Aurora Sinai Medical Center
Outpatient Behavioral Health Clinic