When and how to discuss psychiatric medication with therapy clients

When to Consider a Referral

Let’s start with the basics–when is the right time to refer a client out for psychiatric evaluation? While it’s not always straightforward, there are often clear signs and indicators that a talk therapy client might benefit from medication management.

Recognizing Clinical Indicators

Pay attention to the following clinical indicators with your clients. If they fall into any of the categories below, it may be time to start thinking about a referral. Some of these indicators you may notice right away, even at an intake, like psychotic symptoms or suicidality. Others will rely on your clinical judgment as the client progresses through treatment.

• Severe mood instability, including extreme depression or mania
• Symptoms that significantly impair daily functioning (work, relationships, self-care)
• Suicidal ideation or self-harming behaviors
• Psychotic symptoms such as hallucinations, delusions, or paranoia
• Unclear diagnosis requiring further evaluation
• Co-occurring medical concerns like eating disorders or substance use
• Persistent or worsening symptoms despite consistent therapy

Client-Reported Concerns

Clients may not always directly ask about medication, but they might be giving you subtle (or not-so-subtle) signs. Pay attention if they:

• Express interest in trying medication or ask about psychiatric care
• Have a history of benefiting from medication but are no longer taking it
• Feel overwhelmed and say that therapy alone isn’t helping enough
• Seem increasingly hopeless about their ability to improve

Knowing Your Role as a Therapist

Recommending a client explore medication or have a consultation with a psychiatrist is not the same as prescribing it. Your role is to help clients explore their options, not to make the decision for them. It’s okay if you’re not sure whether medication is the right path for a client—that’s exactly why psychiatric professionals exist! Your job is to support the client in making an informed choice, free of pressure or judgment.

How to Talk to Clients About Medication Management

Because there is so much stigma surrounding mental health in general and especially around psychiatric medication, many talk therapists are unsure how to broach the subject with clients. Remember that your job is to provide clear information and help them process their feelings and options, not guide their decision-making.

Introducing the Topic with Sensitivity

The idea of taking medication can feel intimidating for some clients. Stigma, past negative experiences, or fear of losing their sense of self can all come into play. How you introduce the conversation matters and approaching the conversation with empathy can make a significant difference:

• Normalize medication as a potential tool, not a last resort or a sign of failure
• Acknowledge any fears they have and validate their concerns
• Explain that medication can help regulate symptoms enough to make therapy even more effective
• Offer it as an option to consider rather than something they “have to” do

For some clients, medication can help stabilize symptoms enough to engage in therapy fully. Explaining this can shift their perspective on its role in their healing journey. For example, you might say: “I’ve noticed that despite all the work you’re doing in therapy, your symptoms are still really affecting your daily life. Sometimes, medication can help ease those symptoms so therapy can be even more effective. Would you like to explore this option together?”

Providing Balanced Information

Clients should have a clear understanding of the potential benefits and limitations of medication before making a decision. While this is primarily the psychiatric provider’s responsibility, a talk therapist’s role may include: 

• Highlighting that medication isn’t a magic fix, but can be a helpful tool
• Explaining that it usually works best alongside therapy rather than as a replacement
• Encouraging them to ask questions and express any hesitations

Encouraging Client Autonomy

At the end of the day, the choice is theirs. The decision to pursue medication rests with the client. Your role is to provide guidance, not pressure. Let them know:

• They can take time to think about it and there’s no rush
• You’re there to support them no matter what they decide
• If they choose to pursue medication, you’ll help them find a provider who’s a good fit

Collaborating with Psychiatrists & Medication Providers

Finding the Right Provider

If your client decides to explore medication, you can make the process easier by helping them find the right provider. That might mean:

• Keeping an updated list of local psychiatrists, psychiatric nurse practitioners, and telepsychiatry services
• Helping clients navigate insurance coverage and financial considerations
• Advocating for accessibility, particularly for clients facing systemic barriers

Communicating Effectively

A strong partnership between therapist and prescriber enhances care. Effective communication includes:

• Sharing relevant clinical observations with the prescribing provider
• Encouraging clients to be open with both their therapist and psychiatrist
• Navigating confidentiality and release-of-information agreements to ensure coordinated care

Integrating Psychiatric Care into Ongoing Therapy

Once a client begins medication, therapy remains essential. Therapists can:

• Adjust their approach based on symptom improvement or medication side effects
• Help clients track their progress and discuss concerns about medication
• Reaffirm that medication is not a replacement for therapy, but rather a complement

Conclusion

Recognizing when to refer a client for medication management is a crucial skill for therapists. By embracing a collaborative approach, therapists can ensure their clients receive the comprehensive care they need.

Referring a client to psychiatric care is not a reflection of a therapist’s shortcomings—it is a proactive step toward healing. When symptoms plateau, when hopelessness sets in, when clients are trapped in suffering—bringing in additional support can be life-changing.

Therapists don’t have to do it all alone. Sometimes, the best thing you can do is let someone else take a piece of the weight off your shoulders—so your client can finally move forward.