This presentation will explore the relational aspects of psychopharmacological work with youth and families. While technical and scientific knowledge can be taught and examined during medical education, the therapeutic skills also known as “nonspecific” treatment factors or “common factors” are more elusive and harder to describe.
Differences in culture between the prescriber and the patient often lead to differing perspectives and, if not explored, can interfere with the treatment alliance and subsequently with treatment adherence and/or resistance. Cultural concordance is crucial to teach physicians how to appreciate the cultural background unique to each patient in a way that values and honors our similarities and our differences. In keeping with the adage, The formulation must always precede the prescription, recent work has highlighted the use of the DSM-5 Cultural Formulation Interview as an important tool to more fully understand a young person in the context of their daily life, as part of comprehensive treatment planning.
We propose that the term ‘med check’ is not only a misnomer that simply doesn’t exist in child and adolescent psychiatric treatment (as if the patient just comes to us wanting to ‘talk about their meds’), but more importantly it is a disservice to the nature and intention of our work with youth and families. For such time-limited visits where the medication issues are a primary focus, we propose the term, ‘brief pharmacotherapy visits’, which allows us to retain our role as therapists (as an inextricable part of psychopharmacology). An effective pharmacotherapy appointment necessitates the appreciation of many things that inform treatment, and thus pharmacotherapy decisions, including the intricacies of an individual’s culturally informed, biopsychosocial story. It has consistently been shown that strong therapeutic alliances between a patient and their mental health provider, as well as empathy demonstrated by the latter, lead to more positive clinical and functional outcomes- and thus to the primary goal of evaluating and promoting mental health and well-being.