“If This Were My Daughter”: An Adolescent Psychiatrist’s Perspective
This blog post was sponsored by Monte Nido (Clementine).
I can recall first wanting to become a physician when my mother would take me to the pediatrician’s office when I was feeling sick as a child. Oftentimes, my doctor would sit next to me and calmly explain what he felt was going on and all the options for treatment that were available.
My mother would always reply in the same way, whether I had the flu or needed hospitalization. She would say, “If she were your daughter, what would you do?” To this day, that is how I think about the adolescents we treat, and that is the approach that permeates the air at Clementine. With each adolescent we think, “If this was my daughter, what would I do…”
Thus, upon meeting a new adolescent at Clementine, I typically don’t introduce the idea of taking psychotropic medications for the first few weeks of treatment (provided they are psychiatrically stable), because after years of treating patients with eating disorders, I know the term “psychiatric medications” often sends chills down one’s spine. I find it is much more valuable at this stage of the game to establish rapport. I really want to take the time to get to know the patient, focus on the nutritional aspects of treatment, and try to gain a better understanding of the function of the patient’s eating disorder.
After seeing the adolescent daily for several sessions and establishing rapport, I then may make medication suggestions. Psychotropic medications can be very helpful in the treatment of certain eating disorders, targeting such symptoms as anxiety, depression, obsessive thoughts, and food preoccupations. I spend a great deal of time providing education about the medication, how it works in the body, risks, benefits, and side effects.
I will often tell the adolescent what they will find if they Google the medication and why or why not this may apply to them. I never push medications, though, and often suggest that they take a few days to think about the medication and discuss it with their parents. Similarly, I give the parents the same extensive psychoeducation and rationale for my recommendation.
If the adolescent decides not to take psychiatric medications, I never push or try to convince them to take medication. I don’t believe in trying to convince people to take medication they don’t want to take—especially an adolescent who is in the separation-individuation stage of development where opposition is the rule. Instead, I support the adolescent in their decision all the while, leaving the option for medication open. I find that this open approach, coupled with a relationship that fosters trust and mutual respect, sets a firm foundation for change.
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