Do I Need Medication with Therapy?

As a therapist, I get asked a lot about medications. I cannot prescribe medication, but I can have conversations about what medication can do and how it can work in the brain. I can have conversations about whether or not it is warranted for a particular client at a particular time in their life. I can also have conversations about why a client might be hesitant to start a new medication or stay on one. Sometimes people come into therapy at the request of their prescriber. Other times, clients do not want medication and want to try talk therapy first. Clearly, medication isn’t necessary for everyone, but medication support can help clients see gains from talk therapy more quickly.

As I have these types of conversations over and over, I find myself looking for better ways to explain how medication and talk therapy work together to benefit clients. I frequently explain the role of some antidepressants more like medication to manage diabetes. If one has diabetes, the insulin doesn’t “cure” the diabetes, but it does help manage the symptoms. Lifestyle and medication together provide the best symptom management. However, this analogy falls short for those who haven’t experienced life with someone who is diabetic. So, I was looking for a better analogy, one that would be understandable to both the child and adult clients I see.

Then, the analogy came to me. Have you ever seen little kids learning to swim and the floaties they often wear as they get more comfortable in the water? The floaties keep a kid’s head above water just as medication can keep a client from psychologically drowning in their symptoms of depression or anxiety. The floaties do not teach a child to swim, rather, kids need an experienced person to teach them the new skills required to swim. They need a teacher or coach to support them when they are unsure and to challenge them with more difficult skills as learning progresses. This is precisely the role of the therapist!

As a therapist, I teach new skills to help clients manage their experiences. I encourage clients to practice these new skills in a variety of settings in order to create muscle memory in the body. Over time, a new habit develops and using these new skills becomes a natural response in times of stress. I offer support to clients as they try out these new skills and take bigger risks. I am nonjudgemental, but curious, when clients don’t use the skills outside of session or feel as if they can’t. I help them verbalize what is getting in the way for them.

        During the process of healing old wounds and creating new responses to stressors, some clients are able to reduce their use of medication or remove it altogether. Other clients will be better staying on medication for the rest of their lives, even while doing their very best work in therapy. Whatever decision is made—medication, talk therapy, or both—the best decision for treatment is the one you are comfortable with and will continue. Neither talk therapy or medication will be a “quick fix." Whatever you choose, please know I think you are so brave for being honest and reaching out for help. In my experience, that was the hardest part. I will be forever grateful for the therapist that helped me move from wearing floaties and dog-paddling to swimming laps freely and confidently.