Thinking About Prescribing
The Psychology of Psychopharmacology With Diverse Youth and Families
Our remedies are only as good as the way in which we dispense them
That's the central premise of Thinking About Prescribing, a new volume that encourages pharmacotherapists to view the prescribing of a psychiatric medication to young patients not simply as part of a clinical visit, but rather as the beginning of an ongoing alliance with youth and their parents or legal guardians.
The book makes the case for a partnership that doesn't lean on psychiatric jargon or an encyclopedic list of side effects, but instead on measured candor, vulnerability, and—most importantly—time.
Thinking About Prescribing leverages the knowledge of more than two dozen experts as it tackles topics that include:
- The essential features of the Common Factors approach and the Y-model of psychotherapy, which highlights how relational aspects of pharmacotherapy are key to child & adolescent psychiatric practice, even for brief visits
- How best to utilize the 30-minute Brief Pharmacotherapy Visit (BPV), so that the alliance is nurtured and time is most efficiently utilized
- Techniques, adapted from evidence-based psychotherapies, to enhance medication adherence in diverse youth populations
- Approaches to adapt psychoeducation for culturally diverse populations, and consider why many youth & families may be skeptical of pharmacotherapeutic interventions
- Strategies to cultivate a pharmacotherapeutic alliance when engaging with patients and families via telehealth, including in the school setting
- Tips for pediatricians, advanced-practice clinicians, and other primary care providers who conduct pharmacotherapy
The chapters feature key takeaways that distill the most salient points and that aid in knowledge retention.
Rather than raise unrealistic expectations (two chapters acknowledge the reality of practicing when time and resources are scarce), the goal of this book is to help pharmacotherapists mitigate the stigma, apprehension, or resignation their patients may have and instead build and maintain a trusting relationship that will be key to successful therapeutic outcomes.
- Prescriber, Prescribe Thyself (By Way of Introduction)
- Chapter 1: Think Again About Prescribing: The Psychology of Psychopharmacology
- Chapter 2: The Many Facets of Alliance: The Y-Model, Applied to Child, Adolescent, and Young Adult Psychopharmacotherapy
- Chapter 3: Psychodynamics of Medication Use in Youth with Serious Mental Illness
- Chapter 4: What's in It for Me?: Adapting Evidence-Based Motivational Interviewing and Therapy Techniques to Adolescent Psychiatry
- Chapter 5: Providing Psychoeducation in Pharmacotherapy
- Chapter 6: #KeepItReal: The Myth of the Med Check and the Realities of the Time-Limited Pharmacotherapy Visit
- Chapter 7: Pharmacotherapy or Psychopharmacotherapy: When Therapist and Pharmacologist Are Different People, or the Same Person
- Chapter 8: The Pharmacotherapeutic Role of the Pediatrician, Advanced Practice Clinician, and Other Primary Care Providers
- Chapter 9: The Pharmacotherapeutic Alliance in School Mental Health
- Chapter 10: When Time Is Tight and Stakes Are High: Pharmacotherapy, Alliances, and the Inpatient Unit
- Chapter 11: Telepsychiatry Goes Viral: Psychotherapeutic Aspects of Prescribing Via Telemedicine Amid COVID-19
- Chapter 12: Alliance Issues to Consider in Pharmacotherapy with Transition-Age Youth
- Chapter 13: The Pharmacotherapeutic Alliance When Working with Diverse Youth and Families
- Chapter 14: The Psychopharmacotherapeutic Alliance When Resources Are Limited
- Chapter 15: Building a Therapeutic Alliance in Psychopharmacology During Clinical Trials: Ethical and Practical Considerations
- Chapter 16: The Power of Placebo
- Chapter 17: The Good Enough Pediatric Psychopharmacotherapist: Practical Pointers in Six Parables
- Chapter 18: Teaching and Mentoring the Next Generation of Pediatric Psychopharmacotherapists
- John Azer, M.D.
Barri Belnap, M.D.
Jeff Q. Bostic, M.D., Ed.D.
Arthur Caye, M.D., Ph.D.
Janice Cho, M.D.
Andrew Connor, D.O.
Takesha Cooper, M.D., M.S.
Jennifer Derenne, M.D.
John J. DiLallo, M.D.
Farrah Fang, M.D.
Carl Feinstein, M.D.
Erin Fletcher, M.D., M.P.H.
Shih Yee-Marie Tan Gipson, M.D.
Anne L. Glowinski, M.D., M.P.E.
Srinivasa B. Gokarakonda, M.D., M.P.H.
Simone Hasselmo, A.B.
Amy Heneghan, M.D.
Donald M. Hilty, M.D., M.B.A.
David S. Hong, M.D.
Peter S. Jensen, M.D.
Shashank V. Joshi, M.D.
Mandeep Kaur Kapur, M.D.
David Kaye, M.D.
Christian Kieling, M.D., Ph.D.
Jung Won Kim, M.D.
Brandon A. Kohrt, M.D., Ph.D.
Mari Kurahashi, M.D., M.P.H.
Nithya Mani, M.D.
Andres Martin, M.D., M.P.H.
Jeffrey A. Mills, Ph.D.
David Mintz, M.D.
Katherine M. Ort, M.D.
Tara S. Paris, Ph.D.
Kyle Pruett, M.D.
Sean Pustilnik, M.D.
Elizabeth Reichert, Ph.D.
Magdalena Romanowicz, M.D.
Max S. Rosen, M.D.
Sarah Rosenbaum, M.D., M.P.H.
Anthony L. Rostain, M.D., M.A.
Erin Seery, M.D.
Manpreet K. Singh, M.D., M.S.
Jeffrey R. Strawn, M.D.
Dorothy Stubbe, M.D.
Andrea Tabuenca, Ph.D.
Ian Tofler, M.B.B.S.
Michelle Tom, M.D.
John T. Walkup, M.D.
Isheeta Zalpuri, M.D.
About the Authors
Shashank V. Joshi, M.D., is Professor of Psychiatry, Pediatrics, and Education at the Stanford University School of Medicine and Graduate School of Education, Director of School Mental Health at Lucile Packard Children's Hospital, and a Faculty Advisor at the Center for Comparative Studies in Race and Ethnicity (CCSRE), in Stanford, California.
Andres Martin, M.D., M.P.H., is the Riva Ariella Ritvo Professor, Child Study Center, Yale School of Medicine, in New Haven, Connecticut. He is Medical Director of the Children's Psychiatric Inpatient Service at Yale New Haven Health, in New Haven, Connecticut.
Thank you! These are the first words that come to mind as I reflect upon this wonderful creation that has been bestowed upon our field: Thinking About Prescribing. Thank you for bringing to light something long overdue–resetting, refocusing, restating, and reinvigorating what we as child psychiatrists are trained to do—pharmacotherapy. We are trained to integrate neuroscientific, cultural, biological, social, emotional, and environmental factors that impact and are unique to the children and families we serve in order to devise an effective, comprehensive, and thoughtful treatment plan. That is the practice of medicine. This is the work that must be done at every clinical encounter. Thank you for reminding us that a med check is exactly that—a physician checking the medication. But we are healers. We are trained to check on patients. It is critical that our field gets back to doing just that: listening, hearing, and seeing our patients.—Lisa M. Cullins, M.D., Emotion and Development Branch, National Institute of Mental Health; Co-Chair, Diversity and Education Committee, American Academy of Child & Adolescent Psychiatry
Thinking About Prescribing prescribes thinking and reimagination. It challenges readers to move away from the dystopia of the med visit as a psychiatric vending encounter that dispenses diagnoses and invariably winds up at the Rx e-pad. It strives instead for care that involves two or more curious people considering how a young person's life might be better—and if, how, and when medication might be helpful in that quest. This wrecking ball to the categorical distinction between the psychopharm visit and the psychotherapy session promotes a both/and approach.—Craigan Usher, M.D., Professor and Director of Training in Child and Adolescent Psychiatry, Oregon Health & Science University
As trainees and early-career psychiatrists, with workforce issues and other structural/institutional pressures, we are often called and pushed to be med managers and do med checks. Prescribing is one of the many tools we use to help children and their families in their healing process, yet just as a scalpel is only as good as the hand of the surgeon wielding it, our tools are only as good as how we use them. We know this intuitively but can sometimes get lost with so many competing pressures. Thinking About Prescribing is the perfect antidote for these challenges. The book provides an insightful discussion of the different aspects of prescribing in child psychiatry, from therapeutic alliance principles and realities we confront when prescribing to working with diverse youth and families and using new technologies. I highly recommend this book to all trainees and psychiatrists as we work toward providing the best care for children and families.—Amalia Londono Tobon, M.D., Early Career Psychiatrist-Researcher; Research Fellow, National Institute on Minority Health and Health Disparities; Brown University, Perinatal Psychiatry Fellow '21
Thinking about Prescribing is a cogent exploration of the art and science of pharmacotherapy with young populations in a range of clinical settings. When we prescribe psychiatric medications, our clinical efforts can be enhanced by the synergistic use of psychotherapeutic techniques adapted to the youth's developmental and cultural context. I will urge my colleagues and our trainees to dive into this crucial contribution to the field as we move definitively beyond the med check and toward meaningful engagement with the full suite of therapeutic tools, both medical and psychological, that are the foundations of child psychiatry.—Matthew G. Biel, M.D., Professor and Vice Chair, and Chief of Child and Adolescent Psychiatry, Georgetown University School of Medicine
The role of psychopharmacology in the care of the pediatric patient is increasingly dichotomized as a nonpsychotherapeutic intervention, separate from psychotherapy, as if either exists separately in the treatment for youth and families affected by psychiatric conditions. Thinking About Prescribing is a refreshing alternative to the classic pediatric pharmacology text, integrating psychological and somatic therapies within cultural and relational contexts. The techniques and ideas in this book are essential for child mental health clinicians to incorporate in our daily work.
The entire volume is timely, scholarly, and well conceptualized. The text is nicely organized across age spans, life phases, and treatment settings—making it easy to reference. The authors further highlight the role of culture, race, and social determinants of health when prescribing for diverse populations. This innovative, thoughtful, and timely text is comprehensive yet practical, serving as a how-to guide for trainees and early-career practitioners, and an essential resource for midcareer and senior colleagues.—Tami D. Benton, M.D., Chair, Department of Child and Adolescent Psychiatry and Behavioral Sciences; Executive Director, Children's Hospital of Pennsylvania; Frederick H. Allen Endowed Chair, University of Pennsylvania School of Medicine; President-Elect, American Academy of Child & Adolescent Psychiatry
This collection is a treasure trove with the noble and timely aim of righting the erosion of what it means to be a child psychiatrist—and of what children and their families should mean to us. Clinicians will find in its pages an invitation to revisit the awesome responsibility that is to prescribe medicines by bridging the gap from the molecular to the relational.—Ajit N. Jetmalani, M.D., Director, Division of Child and Adolescent Psychiatry, Joseph Professor of Child Psychiatry Education, Oregon Health & Science University
In Thinking About Prescribing, Drs. Joshi and Martin have convened a group of wise and experienced clinicians who remind us that even the most knowledgeable doctor, versed in pharmacokinetics, will be ineffective if their patient won't take the drug. The psychopharmacologist, patient, and medication must be partners acting in concert. Both newly minted and seasoned clinicians will find lots of helpful insights regarding the art of prescribing across inpatient, outpatient and community settings.—Gabrielle A. Carlson, M.D., Professor of Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University; Immediate Past President, American Academy of Child & Adolescent Psychiatry
Thinking About Prescribing moves us away from seeing psychotropics as treating pathology to helping our patients recognize they are not broken: that medication is but a piece of equipment that does not define the youth taking it. Joshi and Martin remind prescribers that the trust we build with our patients is the foundation of healing: our clinical interactions are the medicine.—Joseph Shrand, M.D., Chief Medical Officer, Riverside Community Care; Lecturer in Psychiatry, Harvard Medical School
In the mid-1960s when I finished my psychiatry training, psychotherapy (dynamic, behavioral, family, group, and psychoanalysis) was the treatment of choice for almost all psychiatric illnesses. There were only a few medicines to choose from then. As more and more meds were introduced into our toolkit, equal measures of optimism and skepticism emerged. Today, however, the pendulum has swung to the opposite corner. In 2021, child and adolescent psychiatrists have largely become psychopharmacologists (med managers): experts in the prescription and fine tuning of the many drugs that are now in our armamentarium.
Thinking About Prescribing attempts to swing the pendulum to the center—to establish an equilibrium and collaboration between the psychotherapies and pharmacology—an undertaking that is so needed at this moment in psychiatry. The edited volume, with each chapter written by skilled and wizened experts, intends to transform pediatric psychopharmacology into pediatric pharmacotherapy. IMHO, it succeeds without a doubt. It is scholarly, innovative (in a readable, pleasant, old-fashioned way), timely, and a must read for all pediatric mental health professionals, including pediatricians. Without the therapy in pharmacology (pharmacotherapy), there is little future for our profession and little hope for our children and their families.—Thomas Anders, M.D., Distinguished Professor of Psychiatry and Behavioral Sciences (Emeritus), UC Davis M.I.N.D. Institute; Adjunct Professor of Psychiatry and Human Behavior, Brown University; Past President, American Academy of Child and Adolescent Psychiatry
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