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Posted July 16, 2003 

Psychotherapy, Medication, & Teens
Thomas E. Carter, M.I.T., Ph.D.
Headmaster/Behavioral Therapist
Shamrock Educational Academy
Newman Lake, Washington
(509) 226-3662

The two different arenas of psychotherapy and medication go hand in hand when treatment involves the behavior and overall mental well being of teens. It is astounding to see how many people today are led to believe that medication alone will heal the wounds of psychiatric problems that are affecting their teens. This is totally inaccurate and a myth.

The latest studies by the American Academy of Child & Adolescent Psychiatry have recommended that medication can be an effective part of treatment when used as part of a comprehensive treatment plan that includes psychotherapy. Without psychotherapy treatment, medications can effectively mask the problem by erecting a medication wall to make the undesired act or behavior go away. Let’s just take for granted that the undesired act or behavior does go away; then ask yourself, what happens when the medication is stopped? The answer is that the undesirable issue will still be just as present and active as it was when the medication was started.

I am NOT advocating abandoning the use of all psychotropic medications when treating teens. Instead, I suggest taking the next step in the treatment process: work on the undesired act or behavior in conjunction with the use of medication. Then the teen can learn how to deal with the problem even if the medication is stopped.

A recent study published in the Archives of General Psychiatry indicated that carefully managed medication results in a better response from children diagnosed with ADHD than therapy alone. For children with co-diagnoses of other behavioral issues, therapy and medication in combination tend to work best, and researchers found that as many as two-thirds of children with ADHD have another behavioral issue. Therapy often reduces the amount of medication necessary for management of ADHD. In other words, medication and psychotherapy work best when used together to obtain a desired norm.

Many parents ask, “What happens if my child will only take the medication but will not attend therapy?” In retort I ask if their doctor prescribes one pill four times a day for an illness, do they only take two pills a day? If we want the most effective means of treatment wouldn’t we complete the entire prescription? There needs to be a distinction in treating patients with behavioral and emotional issues as compared to treating patients with medical conditions, such as sinusitis. Still the questions stand what should we do with the child who does not want to participate in the therapy process. This is where total inclusion may be the most effective option. A treatment facility, group home setting, behavioral institution, mental health hospital, wilderness program, or therapeutic boarding school may be considered. Why? If a child will not take part in the full treatment process to help him or herself then we must ask a question: Is this person thinking or acting in a healthy rational state pertaining to their well-being?

I recently interviewed a young man who was previously diagnosed with depression, Attention Deficit Disorder (ADD), Obsessive Compulsive Disorder (OCD), and Oppositional Defiant Disorder (ODD). His strong resistance to a psychotherapy component is an example of the complicated issues related to approaching psychiatric treatment through medication alone. This young man was admitted to a hospital psychiatric ward at age thirteen, followed by a path that resembled a ping-pong game. He worked with therapists, went to outpatient therapy at a behavioral health center, followed by another admittance into an inpatient psychiatric ward. Then he went to a wilderness program, followed by a therapeutic boarding school, returned as an inpatient client at a behavioral health center, was sent back to wilderness, followed by a return to a boarding school, back to the behavioral health center, and lastly to another therapeutic boarding school where he finally addressed his issues and behavior with a developing sense of honesty and maturity.

When asked what made the last placement work, this seventeen-year-old male stated: “First, I felt that this would be my last chance for some reason. At that point I decided that I had to stop getting kicked out of places. Next, the last place was more of a family environment that dealt with real issues and real time that was not removed from the real world. I also felt that the games were not present, and the therapist in-charge was upfront and honest, telling me where I was and what was expected of me. Lastly, this was a chance for me to participate with the real world again, the world that I was taken away from at thirteen. Once proving myself, I was able to participate in sports and interact with appropriate people outside of the program. Now I’m in a place where I feel I have come a long way. I have been accepted into colleges and I also have a very clear understanding of how my future will play out in a healthy manner with the tools I have learned along the way. And, I have a greater respect for my family, others, and myself. Before that I had a nonexistent type of relationship with my family and now I feel I have a warm relationship with them.”

While considering this miraculous turn around of a young man’s life, it is important to resist the temptation to give all the credit to the last program that this young man attended. We have to look at what he learned along the path he traveled for so many years, before he decided to listen to and use the information that he had received from the numerous professionals he had encountered. This learning process, in combination with the connection and investment he made with the therapist and the program in his last placement, created an opportunity for him to mature emotionally. This is an example of a family that was committed to helping their child and to doing what was in their child’s best interest, no matter how much they had to sacrifice emotionally, physically, and financially.

Some people feel their child will never find help without medication. Yet, there are no silver bullets with medication. It may be necessary, but should always be used in conjunction with therapy, thus completing the whole therapeutic process.

Important Considerations When Your Child is Taking Medication:

  • Adults should always supervise children's medication. I have worked with many parents who assume that their child should be responsible for taking their own medication, which results in missed dosages, over dosages, or not taking the medication at all. The medication must be taken as prescribed for it to be effective.
  • Ask whether your child can take over-the-counter medication, if needed for a cold, upset stomach, cough, fever, etc.
  • Ask your physician what kind of behavior to expect from your child when medicated: short term and long term side effects to watch for, and who to call if there are any problems related to medication.
  • Find out what time of day should your child take his/her medications, and whether it should be taken before eating, with, or after meals.
  • What foods, drinks, and activities should be avoided while using medication?
  • Do not self prescribe for yourself or others unless you are a medical doctor. Medications should only be given to the person it was prescribed for, and no one should take any other person’s medication.
  • Always lock up your child's medication in a location where other children in your family cannot have access.
  • Children should have professional and family support while on medication.
  • Inform your doctor of any other medication your child is receiving from other doctors. Also inform the doctor of any allergic reactions to medications.
  • If your child needs to take medication during school hours, inform the school nurse and ask your doctor to sign a permission slip to give the medication at school.
  • Your child needs to be monitored regularly by your doctor while on medication regarding its use, possible adjustments in dose and need for blood tests and other tests.
  • Adolescents should be educated about the medication by experts.
  • If medication is going to be given by babysitters, relatives or friends while you are out of town, give written instructions about the time of day to give medications, side effects to look for and your doctor's phone number for emergencies.

Considerations When Finding a Therapist for Your Child:

  • It is generally a good idea to talk with more than one therapist, counselor, or psychiatrist on the phone or in person before making a final decision. Many will offer a free initial consultation. Go into the consultation with a list of questions you would like to ask and tell the therapist about your expectations.
  • It is important to choose a therapist who is a good match with you and your child.
  • Make sure your therapist or mental health care provider is licensed to practice in your state or country.
  • Check with your insurance company to see which providers are covered under your plan.
  • Ask about areas of expertise, additional training or certifications.

It is important to recognize that not every teen experiencing emotional or behavioral problems requires medication as a part of their treatment plan. It is often a difficult task for a parent to determine if medication is needed, and many people have preconceived ideas about the use of medication to treat emotional or behavioral problems. As a parent or guardian of a teen, it is vital to approach this issue with an open mind. It is necessary to ask questions, analyze information and have the courage to pursue a second professional opinion if unsure of the treatment recommendations. Then you can be invested in the decisions made during the treatment process. If medication is a part of your teen’s treatment, it is important to remember that psychotherapy and medication go hand in hand. There are no quick fixes. The only true answer lies within the completion of the whole process. We must investigate and pursue all avenues to ensure the safety and survival of our children no matter how strenuous the process might be.

Psychiatric Medication for Children and Adolescents Part 1: How Medications are Used, American Academy of Child and Adolescent Psychiatry, 11/1999, No. 21.

A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder, Archives of General Psychiatry, 1999, Issue 56, pp. 1078-1086.

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