How can you use holistic therapy in an environment where prescribing medication has become the norm? What should you explain to a client when they are misinformed and think that medication can be used as a substitute to therapy? How can you approach the topic of medication to a client who is nervous about it?
MEET SABRINA BASQUEZ
Sabrina Basquez is a therapist and consultant specializing in burnout, secondary/vicarious trauma, trauma-sensitive mindfulness, and self-compassion.
After a decade of working with vulnerable populations, Sabrina personally experienced burnout and secondary traumatic stress. In the final year of her master’s degree, she lost her best friend, in part due to burnout. Over the years Sabrina has observed the personal suffering of countless professionals as they over-dedicated themselves, to often noble work, without realizing the damage they were doing to themselves or their professional efficacy.
These experiences reinforced within Sabrina a passion to collaborate with other professionals in high-demand careers to learn to self-manage burnout, secondary traumatic stress, and workplace bullying through healing past traumas, cultivating self-compassion, interpersonal skills acquisition, conflict resolution, and cognitive mastery.
Visit her website. Connect on Facebook and Instagram.
IN THIS PODCAST:
- It goes back to psychoeducation
- Educating your client about medication
- What to do when a patient nervous about medication
IT GOES BACK TO PSYCHOEDUCATION
In the counseling world, there can be differences in approach: although between the holistic counseling approach and the medical-scientific community approach there can not only be differences but even some conflicts.
This comes down to psychoeducation and some damaging myths that holistic counseling does not use any medication whatsoever, and this is not true.
When [a patient] is that severe, I’m going to talk to them about [medication] and see if it is something [they] are open to, always considering what they want to do with their treatment, and going from there. I believe medication can be helpful as a part of a holistic treatment regime because … some holistic strategies, think of them as complementary … they are part of the greater package. (Chris McDonald)
Holistic therapy uses medication alongside other strategies in a way so that they complement one another, and they do not privilege one above the other as a primary treatment option for a patient.
The medical model and open-mindedness do not need to be mutually exclusive. They can work together and be used together in order to provide the highest quality treatment to a patient.
I think as holistic providers we are open-minded that we don’t want to eliminate medication totally … even if you are totally against it, what is in the best interest of this client? To ask yourself that. (Chris McDonald)
EDUCATING YOUR CLIENT ABOUT MEDICATION
This starts in the first session. If a client is new to therapy then it is important to fully explain to them how the medication works and what they can expect from it.
Explain to your client that some people need medication and that, if the client would like, it can be an option for them should they feel it is necessary alongside your diagnosis. Although, some clients do not want medication and then that is alright as well.
I do talk about [that] sometimes if you do need medication, the best course of treatment research shows is if you have medication and therapy for the best outcomes, and to keep in mind that some people will start medication and stop therapy … but that is only part of it. (Chris McDonald)
Some people think that the medication will help them more than the therapy, or they think that the medication can work in place of the therapy. Therefore, it is important to explain to your clients that the best results come from a joint practice between taking medication – if necessary – and going to therapy regularly.
WHAT TO DO WHEN A PATIENT IS NERVOUS ABOUT MEDICATION
If you have a patient that may need medication in your opinion, but they are afraid of it, you can gently approach the topic with them.
Let them know that they do not have to take it now, and in the meantime, you can try other treatment modalities that they feel comfortable with to build them up to feeling confident to try medication.
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Resources Mentioned And Useful Links:
- Understanding Vibrational Upgrade Energy Medicine with Dr. Alison Kay
- Practice of the Practice Podcast Network
Transcript
[CHRIS McDONALD]
The Holistic Counseling Podcast is part of the Practice of the Practice network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like Behind the Bite, Full of Shift and Impact Driven Leader, go to www.practiceofthepractice.com/network.
Welcome to the Holistic Counseling Podcast for you to discover diverse wellness modalities advice on growing your integrative practice and grow confidence and being your unique self. I'm your host, Chris McDonald. I'm so glad you're here for the journey.
Welcome to today's episode of the Holistic Counseling Podcast. I'm your host, Chris McDonald. Today is the first of a series of live holistic counseling consultations. So this is a little different than a regular guest interview or solo episode that you might be used to. So on these episodes, I have a listener ask one big question they're needing help with, whether it's practice building, self-care or anything else related to holistic counseling. I'm so excited to bring our guest today on. She was actually on my former podcast, Nothing Left to Give. Her name is Sabrina Vasquez. She is the owner of Compassionate Voice Counseling and Consulting in Greensboro, North Carolina. At Compassionate Voice she utilizes trauma sensitive mindfulness, self-compassion cultivation, CBT, DBT, and narrative work to help professionals and adult students to recover from burnout and compassion fatigue. Welcome to this podcast, Sabrina.
[SABRINA BASQUEZ]
Thank you for having me again, Chris.
[CHRIS]
Yes. So tell us more about yourself and your work.
[SABRINA]
Yes, so I am a licensed clinical social worker associate and I just started my own practice as you said, in Greensboro, both very convenient to UNCG. I work with individuals who are adult professionals and often college students. These are usually individuals who have a tendency towards perfectionism, or maybe they have a condition that makes it difficult for them to work. I have a lot of individuals who have people pleasing behaviors and experiences with trauma, and that make it difficult for them, as long as depression and bipolar and things like that, things that create barriers or create situations in which they experience burnout in their workplace. Also workplace bullying, things like that. And so I work with these individuals on basically creating the lives for themselves that are more sustainable.
[CHRIS]
Oh, that sounds great. So what got you interested in compassion, fatigue and burnout?
[SABRINA]
Experiencing it myself.
[CHRIS]
That's always the best teacher.
[SABRINA]
Yes. I'm 42 years old and I can't do that cycle anymore. And I realized it late [crosstalk] I didn't realize it earlier.
[CHRIS]
Much harder to recover the older you get.
[SABRINA]
Absolutely. Absolutely.
[CHRIS]
Yes. So what is your big question?
[SABRINA]
So my big question for you is how is holistic healing accomplished in an environment where it has become normalized to treat normal human suffering with medication?
[CHRIS]
Such an important question. I think everybody in the holistic counseling community needs to hear, because I think the question you're asking is more from the medical model, right?
[SABRINA]
Yes, exactly.
[CHRIS]
Yes. And I'm wondering too, if your population has this question come up or issues come up with your clients.
[SABRINA]
Yes, I do. I have some clients who experience anxiety and they have, I'm thinking of one example of a person who has a dirty use of workaholism, has just always worked, worked, worked. And then they're reaching an age like me where, like they want to slow down, but they don't even know how to slow down and they are learning things like, oh, this is your way of coping with anxiety. But they don't want to use medication. So I'm running into these sorts of things.
[CHRIS]
Yes. So that makes it difficult. And I'm sure you found some people are the opposite too, where they, "Let's fix it with this medication and move on quickly." And that can be a challenge as well, right?
[SABRINA]
Exactly. So I will have some clients where they're like, "Well, the medication's not working for me," but they're also not doing the other work that they need to do.
[CHRIS]
Exactly. And I think some of this goes back to psychoeducation. There's two parts. First part is the myths too, that as holistic providers, that we don't talk about medication and never recommend it, which is not true. And it may surprise you that I do recommend some people, not everyone, only if it's medically necessary for them to get on medication. If I find in my evaluation that they're really struggling, then I really have to look at what are some other avenues. I'll just to give an example. This past week I saw a client, I've been seeing a lot more severe people with really severe, severe depression. Like she couldn't even think straight and was unable to fill out all my forms. Some of the stuff she wrote didn't make sense and I was trying to figure out what is going on with this person. Then I realized, wait a second. So she's severely depressed. So she's not able to, inability to concentrate is really coming through and focus and comprehend. And she was having suicidal ideation. So when somebody is that severe, I'm going to talk to them about, "Hey, you might want to consider this. This is something you're open to," you know, always considering what they want to do with their treatment and kind of going from there.
So I believe medication can be helpful as part of a holistic treatment regimen, because again, some of the holistic strategies we might talk about, even in this podcast, I think of them as more complimentary. It's not necessarily that we're going to go to essential oils as the primary treatment. It's going to be part of the greater package, something to add in addition to other things. And I don't refer everybody, like I said for medication, but it is a hard shift in this country to move from the medical model to being more open-minded about other holistic remedies and what can be out there. So have you given thought to that some of the holistic strategies are more complimentary than the first course of action for treatment?
[SABRINA]
I think my go-to is usually like, trauma-sensitive mindfulness. That's my big one.
[CHRIS]
That's your big go-to? Okay. Which is great. You know, that can be totally part of a treatment regimen too. And looking at, and I also say in the first session that as far as the psycho ed part, that I'm going to look at all the holistic parts of you for treatment looking at what are you eating, what are your eating habits, how often are you eating? Are you drinking water? Are you drinking soda? Those things that some people don't think about that affect energy, mood, overall mental health, exercise, is a big one I talk to clients about, especially with depression, looking at spiritual practices. So thinking about it in combination, all of those things together, if they're already on medication because one of the things ethically too, we don't want to say is get off your medication because that's harmful and we're supposed to do no harm as part of our ethical practice.
And you always want to, if they want to make changes in medication, you don't want to say anything either because that can be dangerous and make you liable. I always say, you need to talk to your psychiatrist or doctor about that. If they want to change medication, if they think by going to a holistic provider I'm good now so I can just get off this medication because I'm seeing you. That is not your decision. Because we're not licensed professionals. So you got to walk that thin line with that, okay, let's be really cautious. And any medication specific questions about, "Oh, should I go up in my dose?" You need to talk to your doctor about that. So that's your answer for any of those specific questions with that.
But I think it is so important though, to be open-minded. I think as holistic providers, we are open-minded that you don't want to eliminate medication totally and say, "Oh, I can never talk about it now. It's not in my vocabulary, even if you're totally against it." What is in the best interest of this client, to ask yourself that.
[SABRINA]
Yes. And so what do you do when the psychiatrist that a client is seeing, like you disagree with that psychiatrist?
[CHRIS]
Oh, that's tough. Well, I like to get, what do you call it? Release of information and talk to the psychiatrist as well for the clients that are on medication so we can be on the same page and try to get their input. Of course we can't change their mind about therapy, but hopefully if they'll talk to you, because again, there are some that won't. That gives you a message right there, what they think of therapy. But I like to just be on the same page with them and let them know what I'm doing, what kind of treatment modalities I'm doing so they understand and that we can build some kind of collaboration and partnership to help this client the best way that we can. Does that make sense to you to be able to reach out to them and ---
[SABRINA]
Yes. And to engage in that coordination of care, definitely makes a lot of sense. And I'm just thinking, so what do you do in this situation where the psychiatrist is not engaging with you and you have things to say about the client and maybe they're not calling you back or their coordination of care game is not on par?
[CHRIS]
That's difficult because I don't know that we can do much. Maybe somebody else has an answer for that. I don't know. Because I've had that. It's like, okay, like I reach out and do my best. But again, I think talking to them, your other question too, about if you don't like what the psychiatrist is saying, is that coming from the client because sometimes they may get misinformation or misinterpret what the psychiatrist is saying.
[SABRINA]
Yes. And that's why you want to be able to talk to them so you can figure that out.
[CHRIS]
Yes, to figure out. Majority of them well, I will give credit where credit is due, but sometimes I've had a few that just for whatever reason, they have too much going on and they don't get back to you. But so just to clarify those questions with them too, because you don't know if the client has it all straight that, oh, my psychiatrist told me this. They may be, the client could be manipulating you in some way.
[SABRINA]
Yes. And so tell me a little bit about what, on our level, a master's level, I think you're master's level too.
[CHRIS]
Yes.
[SABRINA]
A master's level clinician, what is appropriate psycho-education for our clients in regards to medication?
[CHRIS]
That starts in the first session. And what I do is talk about, especially people that are new to therapy, I think you have to go a little step further. Of course it's more work on our part, but it's so essential that we do that because they don't know, they don't know what to expect and they're uncertain. They don't even know what questions to ask. They don't know what they don't know about the whole process. They may know what they've seen on TV, which may give like sopranos. You know, they may think that counseling's like that and have some wrong ideas or things that aren't true. So I usually start by saying too, that sometimes for some people they might need medication. And I'll talk to you about that and see if that's an option for you because not everybody wants medication. I totally get it. I've never pushed it on someone, but I would just kind of, how do you feel about it is usually how I ask.
What do you think about medication? Is that something you've considered just to kind of feel my way with them if I feel like they might need some. But most people have an idea by the time they reach out to us, if they haven't already gone to a primary care or psychiatrist. They have some idea. But then I do talk about, sometimes if you do need medication, the best course of treatment research shows is if you have medication and therapy for the best outcomes. And to keep that in mind that some people will start medication and stop therapy thinking, "Oh, well, I'm good now. I got my medication, but that's only part of it. And I think that's what you're asking too, is some people will say, "Oh, I don't need to do therapy. I just want the pill to fix me." Quick fix in our society, which unfortunately gives the wrong message too, because this is something that can take some time and process.
And that's why I ask people how old they are, because there could be decades of thought patterns that are getting in their way that are causing problems. So they do need to consider that this is going to take some time and effort on their part. And I will say to them too, "I need your help." So when you are going through therapy, I'm going to ask you to do some client homework and what is homework involvement. And I try to give examples too, because some people aren't really sure what that means. That might cause more anxiety and anxious clients and just let them know it could be a breathing exercise, could be a mindfulness practice, just something small to start adding to your everyday life. And the more that you put into that, the more you're going to get out of it. So if you choose not to do that, that's okay too.
There's no grades on that too. You won't get an F. Because it brings back, sometimes you say homework too, I know people get reminded of school and getting bad grades. And so if you don't do it, we'll talk about it. If you do it, we'll talk about it. So just looking at it as a no judgment zone, but this is what's going to help you get better and be able to work through things. And just letting them know that medication could be a part of it. Doesn't mean it has to be and let them know what does holistic treatment mean, just going into more details of that. And this is, I always say, this is your time to talk about whatever's on your mind and go through the confidentiality and let them know that, "I want things to be open. If there's something you have questions of, this is totally fine to ask your therapist questions about things you're uncertain of about the process." Just opening that door for new clients too so they have a better idea. Does that answer your question?
[SABRINA]
Kind of, I mean, I'm really thinking about the idea of pyschoeducation in regards to symptoms and in regards to side effects. Yes, as far as where our limitations on providing that psychoeducation.
[CHRIS]
So symptoms of like depression or something specific disorder?
[SABRINA]
Yes. As it might relate to medication. So I'll give you for an example, a client who started taking ADHD medication and you notice is depressed and realize that maybe it's the ADHD medicine which is kind of, you know it's notorious for making people feel kind of zombified and contributing to them having those feelings. And then where is your limitation on what your ---
[CHRIS]
Oh I see.
[SABRINA]
Is it to say, "I noticed that this is happening. It could be a medication."
[CHRIS]
Could be. So you don't want to give definitive to say, "Your ADHD medicine is causing this," because we don't know, and we're not the prescriber. "So this is something that you should talk to your doctor about because I'm not sure, but this is from what you're telling me and what I'm seeing." And you can share too, and say, "Hey, this was a potential side effect." Everybody, general public can look up potential side effects. So we can say that too, that this could be a potential side effect, just like with a black box for young adults, with some of the depression medications, with suicidal thoughts. You know that's always a warning that they could have more suicidal ideation. And if that happens, I've I had a client that happened to be 17 year old that started getting a lot more suicidal thoughts after taking medication.
So I talked to the parent, talked to the child about that and said, this could be potentially from the medication. So you need to talk to your doctor and get in as soon as possible. So just saying, be careful with the language around it because we don't know, we can't give definitive answers, but you never want to say it's definitely because how do you know that? And it could be other factors.
[SABRINA]
Yes, that's a really good point. Have you ever had a client who's just absolutely terrified to take medication like they're having panic attacks? Because I have those where they're having panic attacks and they go and they get prescribed medication, they take their medication and they're like, "Oh my God, this medication is going to kill me." So they're like literally feeling phobic of taking a medication.
[CHRIS]
I've not had that. But I would think that you'd have to go through some therapy too, to work through some of that and maybe do some successive approximations to really break that down into small steps and doing some relaxation and be able to work through that before the medication. Because with anxiety too, I always start with, we got to calm the body before we get to any thought processes or anything else. We need to do some breathing, we do some mindfulness grounding, whatever it takes to calm the body and mind and before we move on to anything else. And some people too, if it's not severe depression, maybe they're on that borderline of, "Oh, I'm so bad right now, but I'm not sure I can handle it much longer." But if we're able to work through in therapy, some people want to do that first as another option.
And maybe that highly anxious person, maybe medication isn't right for them right this second. And that you can try some other and you just give them that option, "Well, maybe that's not right for you right now, but we can go ahead and just try to work on some holistic strategies and do like your trauma sensitive mindfulness to work on that first and see how that goes."
[SABRINA]
And use that experience as a way to have them rule out whether or not they rule in whether or not they think medication is actually appropriate for them.
[CHRIS]
Right. Yes. So does all that answer your, I feel like I've talked a lot. The answers, that's all I got to lose. I was like, "Wait, did I answer all the questions?"
[SABRINA]
Yes you did. I really get the overview on just how a holistic practitioner will look at medics.
[CHRIS]
I mean, that's how I do. I don't know if I'll do, but in general I think just keeping, we got to be open-minded about all of this too.
[SABRINA]
Yes. That makes a lot of sense, being open-minded about medication and being helpful for a client, even though you're not going off of the medical model necessarily yourself.
[SABRINA]
Yes. Yes. True. So what do you think you want to take away? Anything else from our talk today Sabrina?
[SABRINA]
Yes. I think I want to take away really addressing medication in the beginning of my time with the client more thoroughly, instead of just asking, "Are you on something?" and taking that down or saying, "Are you on something?" And then if you are like, just really talking about it with the client in more detail.
[CHRIS]
Yes, exactly.
[SABRINA]
And also I think that's also a great time to explore some of the things that you said. Like, [inaudible 00:19:52] I also explore sunshine and ---
[CHRIS]
That's true too.
[SABRINA]
Those are two really big ones.
[CHRIS]
Definitely.
[SABRINA]
Yes. So I think ---
[CHRIS]
So that might be a good episode we could do on assessment with a holistic counseling, right?
[SABRINA]
Oh yes. That would be great. Exactly.
[CHRIS]
Excellent. Well, thanks for coming on today for this. I know this is a little different than the regular kind of guest interview.
[SABRINA]
Yes, I loved putting you in the hot seat Chris.
[CHRIS]
Of course. Awesome. But I want to thank everyone for listening today. And how did you like the live consultation interview set up? A little bit different. Shoot me an email. I'd love to hear from you at chris@holisticcounselingpodcast.com. And remember to subscribe, rate and review. If you haven't done that yet. This is Chris McDonalds sending each one of you much light and love. Until next time, take care.
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