When are psychotherapy and medication recommended together? Learn how psychologists and psychiatrists collaborate, common misconceptions and how it works.
"Should I go to therapy, or should I take medication?" Many people going through a psychological difficulty ask themselves this question. Behind it there are often worries too: "If I take medication, will I become dependent?", "Wouldn't therapy alone be enough?", "If I start medication, will I no longer need therapy?" Yet in most cases psychotherapy and medication are not alternatives to each other but two different paths that complement each other. In this article we look at how the two approaches work, when they can be used together, how a psychologist and a psychiatrist collaborate and what you should pay attention to during the process.
It should be said at the outset: this article is for information purposes. Any decision about medication can only be made following an assessment by a psychiatrist. Psychologists do not prescribe, recommend or adjust medication.
How Do Psychotherapy and Medication Work?
To be able to think about the two approaches together, it helps first to understand what each of them aims at.
What does psychotherapy aim at?
Psychotherapy is a structured process that helps a person understand their patterns of thought, emotion and behaviour, process challenging experiences and develop new coping skills. There are different approaches such as cognitive behavioural therapy, schema therapy or play therapy, but what they all have in common is that change comes about through the person's own awareness and skills. The skills learned in therapy stay with the person after therapy ends, which offers a kind of protection against future difficulties.
What does medication aim at?
Psychiatric medications aim to reduce the severity of symptoms by acting on certain chemical and biological processes in the brain. For example, in situations such as severe depressive symptoms, intense anxiety, sleep disorders or marked swings in mood, medication can ease symptoms and allow a person to reorganise their daily life. Medication is started, monitored and, when necessary, adjusted by a psychiatrist.
How do the two work together?
One way of thinking about the two approaches together is this: severe symptoms can make it harder for a person to put into practice what is discussed in therapy. Let's say someone is experiencing such intense depression that they struggle to get out of bed in the morning, to come to sessions or to focus on what is being said. In this case, medication can reduce the severity of symptoms and lay the ground for the person to take an active role in therapy. Therapy, in turn, helps the person understand how this difficulty arose, change the patterns of thought and behaviour that maintain it, and develop skills against the risk of recurrence.
Research shows that for some moderate and severe psychological difficulties, using psychotherapy and medication together can often offer an advantage over either method alone. This is, however, a general tendency; which path is right for each person must be assessed individually.
When Are Psychotherapy and Medication Recommended Together?
No single criterion determines the decision to combine treatments. However, this option may come up for consideration in the following situations:
- When symptoms are severe: Situations such as depressive symptoms that seriously affect daily functioning, intense and frequent panic attacks or long-standing insomnia.
- When there is a safety risk: A psychiatric assessment is important where there are thoughts of self-harm or of ending one's life.
- When symptoms have lasted a long time or keep recurring: Depressive episodes that have occurred more than once, or anxiety that has lasted for years.
- When there is no expected progress despite therapy: If symptoms clearly continue despite a regular and appropriate course of therapy, a psychiatric assessment can bring a fresh perspective to the process.
- When certain diagnoses are involved: In conditions such as bipolar disorder or psychotic symptoms, for example, medication is generally a core part of the process, while psychotherapy takes a supportive and complementary role.
- When physical causes need to be ruled out: Because thyroid problems or other medical conditions can produce pictures resembling psychological symptoms, a doctor's assessment is important.
For many mild and moderate difficulties, psychotherapy on its own can be considered as the first option. Which path to follow is decided together, according to the severity and duration of symptoms and the person's past experiences and preferences.
What about children and adolescents?
When it comes to psychological difficulties in children and adolescents, psychological assessment, family sessions and age-appropriate psychotherapy methods are generally given priority first. Play therapy, parent counselling and collaboration with the school are important parts of this process. That said, where symptoms seriously affect the child's development, school life or safety, an assessment by a child and adolescent psychiatrist may be needed. This assessment does not mean that medication will necessarily be started; the doctor looks at the child's situation as a whole and recommends the most suitable path. It is important for parents to ask their questions openly during this process, share their worries and give their child a calm explanation suited to their age. Describing treatment to the child not as a punishment or as proof that they are "broken", but as a step taken to help them feel better, makes it easier for them to take part in the process.
Medication can sometimes calm the waves, while therapy teaches how to swim in them; the two can answer different needs of the same sea.
How Do a Psychologist and a Psychiatrist Collaborate?
The roles of a psychologist and a psychiatrist are different. A psychiatrist is a specialist with medical training who can make a diagnosis and start and monitor medication. A clinical psychologist specialises in psychological assessment and psychotherapy and does not prescribe medication. You can find the differences between the two professions in more detail in the article on the difference between a psychologist and a psychiatrist.
Good collaboration makes the process far more complete for the client. This collaboration can take the following forms:
- Referral: When a psychologist thinks, during the course of therapy, that a psychiatric assessment is needed because of the severity of symptoms or a safety risk, they can refer the client to a psychiatrist. Similarly, a psychiatrist can refer their patient to a psychologist for psychotherapy.
- Sharing information: With the client's written or explicit consent, the two specialists can share the necessary information about the progress of the process. This sharing is not done without consent.
- Joint observation: The psychologist can help the client prepare for a meeting with the doctor by noting down, together with them, the changes observed in weekly sessions (for example sleep, energy and mood).
The client's role
In this collaboration, the most important person is you. Both specialists need to hear your experience. Telling your psychologist that you have started medication, that your treatment has been changed or that it has been stopped, and telling your psychiatrist about important changes you are experiencing in therapy, helps the process be managed in a healthier way.
Common Misconceptions
There are some widespread beliefs in society about psychotherapy and medication. Some of them can keep people away from the support they need.
- "Taking medication is a weakness." Psychological difficulties are not a matter of willpower or character. Just as receiving treatment for blood pressure or diabetes is not a weakness, neither is receiving treatment for psychological symptoms.
- "Psychiatric medications make everyone dependent." This generalisation is not true. Matters such as the effects of medications, possible side effects and how to stop them should be discussed with your doctor. Asking about your concerns openly is the healthiest way.
- "If I've started medication, I don't need therapy." Medication can ease symptoms, but on its own it does not change the patterns of thought and behaviour, relationship patterns or unprocessed experiences that maintain the problem. For this reason, in many cases the therapy process has a complementary importance.
- "Therapy is just talking and doesn't work in severe cases." Therapy involves structured and evidence-based methods. In severe cases it may not be enough on its own, but it holds an important place in combined treatment.
- "I can stop the medication once I feel better." The decision to stop medication must be made together with the doctor. Stopping on your own and suddenly can lead to a return of symptoms or unwanted effects.
What Can You Do for Yourself During Combined Treatment?
If you are continuing psychotherapy and medication together, the following suggestions can make the process more productive:
- Keep a symptom diary. Record your sleeping hours, energy level, mood and any changes you notice in brief notes. These notes give concrete information for your meetings with both your therapist and your doctor.
- Write down your questions. Note the questions you are curious about before going to a meeting with your doctor. It is easy to forget them in the nerves of the appointment.
- Keep your expectations realistic. The effect of both medication and psychotherapy emerges over time. Not feeling a marked change in the first weeks does not necessarily mean the process isn't working.
- Keep communication open. If there is a change you think is a side effect, a hesitation about taking medication or an issue you are struggling with in therapy, tell the relevant specialist.
- Do not neglect basic life habits. Regular sleep, nutrition, physical movement and social connection support the effect of both treatments.
- Be careful with alcohol and substance use. These can affect both your mood and the effect of treatment negatively; talk to your doctor about this.
- Do not blame yourself. Needing treatment is not a flaw. A compassionate attitude toward yourself is an important part of the recovery process.
When Should You Seek Professional Support?
In the following situations it is recommended that you approach a mental health professional without delay:
- Low mood, loss of interest, hopelessness or feelings of worthlessness lasting more than two weeks,
- Marked difficulty keeping up with daily tasks, your job or your studies,
- Serious changes in sleep and appetite,
- Intense anxiety you cannot control or recurring panic attacks,
- A feeling that your connection with reality is weakening, or experiences such as hearing voices that others do not hear,
- An increase in alcohol or substance use.
These symptoms alone do not amount to a diagnosis, but they indicate that a specialist assessment may be needed. For general information on depressive symptoms, you can look at the article on symptoms of depression.
If you are having thoughts of harming yourself or ending your life, call 112 (emergency services) or go to your nearest emergency department without waiting for an appointment. In these situations both a psychiatric assessment and a safety plan take priority. If you notice these symptoms in someone close to you, listening to them without judgement and being beside them as they reach a specialist is also a very valuable form of support.
How Is Combined Treatment Handled in Therapy?
When medication comes up during the psychotherapy process, the therapist talks about it with the client openly and without judgement. Within a cognitive behavioural therapy framework, the client's beliefs about medication are among the subjects that can be addressed. For example, thoughts such as "If I take medication, I'll be admitting I'm really ill" or "If I can't get better on my own, it means I'm weak" can lead a person to keep away from the support they need. Examining these thoughts together helps the person make the decision from knowledge rather than fear.
While medication continues, therapy generally focuses on these areas: noticing the patterns of thought and behaviour that maintain symptoms, approaching avoided situations step by step, developing emotion-regulation skills and creating a relapse prevention plan against future difficulties. As the doctor prepares to bring medication to an end, the skills acquired in therapy can help the person feel safer.
Where deep-rooted, long-standing patterns are involved, schema-focused work can also accompany the process. While this work addresses the person's core beliefs about themselves and their relationships, the easing of symptoms through medication can lay the ground for this deeper work. For information about the psychotherapy process in depression and mood difficulties, you can visit our page on depression and mood.
Frequently Asked Questions
Can a psychologist prescribe medication?
No. Psychologists cannot prescribe, recommend or adjust medication. All decisions about medication are made by a psychiatrist. A psychologist, when necessary, can make a referral for a psychiatric assessment.
Can I continue therapy while taking medication?
Yes. In many cases it is recommended that psychotherapy and medication continue together. Letting your therapist know that you are receiving medication helps the process be carried out in a more integrated way.
Is it possible to try therapy before starting medication?
For many mild and moderate difficulties, psychotherapy can be considered as the first option. However, if symptoms are severe or there is a safety risk, a psychiatric assessment should not be put off. This decision should be made after your symptoms have been assessed by a specialist.
Can therapy help me stop taking medication?
The decision to stop medication should only be made together with your doctor. That said, the skills gained in therapy can help you feel better prepared during and after the period in which your doctor brings medication to an end in a planned way.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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