I have had a long-term interest in the psychopharmacology of the central nervous system. I studied biology as an undergraduate and received an MA in 1971 with an emphasis on molecular biology. My interest in human nature led me to leave biochemistry and continue my education in the field of psychology, and to complete a PhD.
It is this combination of advanced training in both psychology and biology that has led to my teaching psychopharmacology, which I have been teaching to psychology graduate students since 1984. What follows is a brief outline of how I use Drugs and Clients in my own course: Psychopharmacology for Psychotherapists.
In California, where I teach, psychopharmacology is now a required course before licensure for all students who plan to sit for the Psychologist or Marriage and Family Therapist license. I am not certain how many other states also require it, but it is safe to assume that if it isn't already a requirement, it is being considered by other state licensing boards. Psychopharmacology is required by the American Psychological Association as part of the curriculum for students at the graduate level who are studying toward a PsyD. or a PhD. in psychology. Prior to 2001, psychopharmacology was an elective for MFTs in California, and it was not offered at many schools. After it became a requirement, I received many requests from graduate schools to teach it, as there were not many people in the field of psychology with an adequate knowledge of the subject. Schools throughout the state had to draft faculty with minimal training in pharmacology or biochemistry to teach a graduate level psychology course in this very complex area.
I have not found another text that has been designed specifically to meet the needs of practicing psychotherapists, graduate students, or those who are teaching to this audience. In Drugs & Clients I have included the drugs that are most commonly used or are representative of each category, and it does not include details on all the drugs in each class. There are simply too many on the market for this to be practical. This information is available in psychiatry texts, or for the most up-to-the-minute information, one can use on-line search tools. If you or your students are interested in further information on any topic, the references in Drugs & Clients will lead you to many books and research articles for each specific drug or substance. Since it is designed specifically for the non-prescribing professional, it is my hope that Drugs and Clients will specifically address the needs of the instructors teaching psychopharmacology and benefit their students.
Padma Catell, PhD, May, 2010
is an abbreviated teaching guide adapted from my current syllabus:
Psychopharmacology for Psychotherapists
The goal of this course is to
study the range of current psychopharmacological interventions
in terms of mental disorder diagnostic categories, including
antidepressants, antianxiety drugs, mood stabilizers and antipsychotic
drugs. Neurobiological mechanisms of the drugs used to treat
mental disorders are reviewed in terms of current research.
(These are constantly being revised, so be sure to inform
the students that the material may have changed.) An extensive
explanation of the process of sleep and the sleep disorders
is also covered. Interaction of psychopharmacological and
psychotherapeutic interventions is discussed, including medication
responses and side-effects.
Primary Course Learning
• To introduce students
to the basic workings of the nerve cell.
• To introduce students to the classes of drugs used
• To provide students with an understanding of how the
psychoactive drugs work.
• To provide students with an understanding of when
medical consultation or supervision is needed.
• To help students become
conscious of their own biases towards medications.
• To help students to develop a balanced view of when
medications are appropriate and what medications can, and
• To help students become more knowledgeable so that
when they consult with psychiatrists they can be more confident.
Criteria for Evaluation
I do not use an in-class test
for my psychopharmacology course. Instead, students are required
to write two papers that illustrate a basic understanding
of the subject. The following is from this semester’s
Students will be evaluated at the mid-point and at the end
of the semester. The evaluation will be based on development
and discussion of case examples of clinical situations involving
the various drugs or treatments covered.
This material is to be presented in papers 5–8 pages
long. Each paper is to cover at least two of the classes of
The first paper is to be based on examples that cover the
material from the first half of the course Appendices A, B,
C, and E and Chapters 1–6.
The end-of-semester paper will be based on the material from
the second half, chapters 7–11. The example cases presented
can be hypothetical, or based on your experience with clients,
your personal experience, or your knowledge of a friend or
Here's a typical example
case and questions to consider and address when writing your
A client comes to see you requesting
treatment for anxiety and panic attacks. He is well dressed
and has a job as a stock broker. He is 29 years old. He reports
that he has panic attacks while on the floor of the stock
exchange. You can smell alcohol on his breath.
A paper on this case might
discuss the following:
• diagnoses to be considered
• treatments for the panic disorder, including choices
for pharmacological interventions
• reasons why different pharmacological treatments might
be recommended or contraindicated for this client
• how the therapist should approach the alcohol issue
• appropriate interventions for alcohol withdrawal
In the papers you will be expected to reference the various
neurotransmitters or neuromodulators (when known) that are
primarily involved with specific psychological conditions.
You will be expected to reference the appropriate classes
of drugs, and the use for each class of drugs, for the appropriate
treatment for your case.
You will not be expected to know the names of specific drugs
or the mechanisms of actions for specific drugs. You will
not be required to know the material in the Appendices. You
are expected to read the Appendices for your own background
I hope that the above evaluation
procedures may prove useful to other instructors in evaluating
their students’ comprehension of the material.
Reading Schedule and
Psychopharmacology is usually
taught either as a 2 or 3 unit course in a 12 to 15 week semester
class. The following presentation will have to be adjusted
to accommodate schools on quarter or trimester systems, as
well as the many differing class schedules of schools on traditional
semesters. I have tried to outline the pacing that has worked
well for me.
As a general rule I begin each class (after the first meeting)
by asking the students if there are questions or points from
the previous class, or the readings, that need clarification.
Whenever time allows, I have one of the students bring in
a case example for the class to work on together, viewing
the client from a psychopharmacological perspective. The student
presents a brief outline of the case, and then the rest of
the class asks the questions necessary to make an evaluation,
and then a recommendation, as to what is needed in terms of
medication, or whether the medication that the client is currently
on seems appropriate. This class work on the example cases
prepares the students for the format that is required for
their papers. The students seem to enjoy the example-case
work, and are grateful for direction on how their papers should
be written. The student presenting the example invariably
gains some new insight on the client, and an interesting time
is had by all.
The Nerve Cell & the Brain; Studying the Brain;
Transmitter Substances; Other Types of Drug Responses
Reading: Preface, Appendices A, B, C & E
One of the greatest challenges
I found in writing Drugs and Clients was how to present the
material to two different audiences: clinical therapists and
graduate students. I settled on writing the book as if I were
speaking directly to my fellow therapists, which meant putting
the background material in the Appendices for those who were
interested. Students are usually not familiar with the basics
of the nerve cell, blood-brain barrier, and transmitter substances,
and need to be well-grounded in these basics in order to assimilate
the material to come. Therefore, when teaching Psychotherapy
for Psychotherapists, I begin the first meeting not with Chapter
One, but with the basics found in Appendices A, B, C, and
In the first class session I
review the basic structure of the nerve cell, neuronal transmission
and the role of the neurotransmitter substances. I also explain
the role of the blood-brain barrier in drug availability to
the CNS. I review the concepts of placebo response, allergic
reaction, and various types of tolerance. This review allows
the students to have the same basic knowledge at the start
of the class. For the rest of the semester it will be assumed
that these concepts have been understood.
Sleep & Treatment for Sleep Disorders
Reading: Chapter 1
The first two chapters of the
book are about sleep because it is important for therapists
to understand a client’s sleep patterns and problems
when making an assessment, and because sleep is not covered
anywhere else in psychology curricula.
Patterns of sleep and sleep disturbances
can be symptomatic of mental disorders, specifically the disorders
of depression and anxiety. Recognition of this can be essential
in making an accurate diagnosis. Sleep problems themselves
can cause psychological problems, particularly problems with
anxiety and difficulty concentrating. Anxiety and depression
often cause problems with sleep, and some sleep disorders
can easily be misdiagnosed
Medications used to treat psychological problems often affect
sleep patterns, and medications given to help with sleep can
worsen some psychological problems, particularly depression,
and sometimes can lead to an addiction to the sleep medication
itself. Withdrawal from sedatives after a person has become
physically dependent on them can be life-threatening, and
requires medical supervision.
At the end of this class I often show clips from the film,
My Own Private Idaho, which has a young man who has narcolepsy
as one of its main characters. This may overlap into week
Treatment of Insomnia & Anxiety Disorders
Reading: Chapter 2
I begin this meeting by encouraging
the students to include questions about sleep patterns in
their patient history forms. Students are eager to talk about
their own sleep problems. This always gets a good discussion
Insomnia is a very general term used to describe a multitude of sleep problems. As students know after last week's class, it is more useful to determine specifically what type of sleep disorder a client has so that appropriate treatment can follow. An inability to fall asleep is usually associated with anxiety disorders, whereas early-morning awakening (around 4 AM) is associated with depression (depression is discussed in detail in Chapter 4). Withdrawal from the BzRAs (and all sedatives) can be life-threatening and requires medical supervision. If there is time, I show a short video with people who have Panic Disorder describing their experiences and symptoms.
Alcohol: Use & Abuse
Reading: Chapter 3
Although my state’s licensing
board requires that students take a course on alcohol and
chemical dependency, I believe that it is important to also
learn about the pharmacological substances that are currently
available that can ease withdrawal. I focus on the various
psychological effects of alcohol consumption, and what therapists
have to know about alcohol and how this affects psychotherapy.
Alcohol is one of the most widely
used drugs in our society, and it is relatively inexpensive.
Alcohol is often used to "self medicate" for psychological
problems. Long-term alcohol use can lead to specific mental
problems, dementia and delirium. Withdrawal from alcohol can
be life-threatening, and requires medical supervision.
Treatment of Depressive Disorders
Reading: Chapter 4
Depression may be the most common
symptom psychologists encounter in their clients. With the
wide-spread use of modern psychopharmeceuticals, it has become
more important than ever for the therapist to have a basic
understanding of how these medicines might affect their clients.
I take two full class periods to discuss depression.
A client who is extremely depressed
and apathetic may not be able to work effectively in psychotherapy.
The client may not have the energy required to gain access
to psychological information. Given the client's limited energy
resources, even expending the energy required to get out of
bed and come to therapy may be difficult. There are many types
of interventions for the treatment of depression--cognitive,
behavioral, psychodynamic, and pharmacological. All can be
effective. Treatment must be tailored to suit the patient.
When a client is depressed there may be some situations where
it is life-threatening to wait the length of time it takes
for change to occur through psychotherapy alone. Indications
for when medications should be considered are when a client
is losing weight rapidly (more than 15 pounds in three weeks)
or is actively suicidal.
Treatment of Depressive Disorders (continued)
Reading: Chapter 4 (cont.)
This is the approximate half-way
point. I ask for an informal evaluation of the class, and
have the students give feedback as to how they would like
the class to be improved. I do my best to incorporate these
changes into the rest of the semester.
I ask for comments and questions
regarding the discussion of depression in the previous class,
then present the pros and cons of the various groups of antidepressant
drugs as well other treatments for depression: ECT, rTMS, DBS and VNS.
Treatment of Bipolar Disorder
Reading: Chapter 5
By the end of this class most
students come to realize that they have had direct experience
with someone who has bipolar disorder. I emphasize the nature
of the disorder as well as the various pharmacological approaches
The defining symptom of a bipolar
disorder is the presence of a manic or hypomanic episode.
The Diagnostic and Statistics Manual IV (DSM IV) does not
include a diagnosis of manic disorder alone. If manic symptoms
present, the usual diagnosis is bipolar disorder. Most therapists
agree that when a client is very agitated or in a manic episode
it is not possible to do psychotherapy. Bipolar disorder is
thought to be primarily a biochemical
imbalance. Consultation between the psychotherapist and the
psychiatrist is imperative when bipolar disorder is suspected.
Patients may not tell the psychiatrist about their manic symptoms.
Many antiseizure drugs and antipsychotic drugs are emerging
for the treatment of manic episodes.
CNS Stimulants: Use & Abuse
Reading: Chapter 6
Almost all students have experience
with one or more of the CNS stimulants, most often caffeine
and nicotine. Because of their own use of these substances,
students have a personal investment in learning about
the pros and cons of these commonly-used stimulants. The personal-use
factor usually generates an interesting class discussion.
Stimulants, primarily amphetamine-like
compounds, are often used to treat children or adults with
attention deficit or hyperactivity symptoms. They can also
be used appropriately for the treatment of depression when
immediate response is necessary, since it usually takes a
few weeks for antidepressants to reach their maximal effect.
Stimulants can be useful to energize people who are too depressed
to get out of bed who, once they are up, can embark on a behavioral
plan to lessen the depressive symptoms. Psychopharmacological
treatments for stimulant addictions (including nicotine) are
Treatment of Psychotic Disorders
Reading: Chapter 7
I begin this class with an explanation
of the evolution of the terminology used to describe the antipsychotic
medications. I explain that these drugs are primarily useful
in treating psychoses, in whichever mental diagnosis it is
present, including mania, depression, a drug induced psychosis,
or schizophrenia. I discuss the difference between positive
and negative symptoms of schizophrenia, and explain that psychotherapy
is most helpful for the negative symptoms, and medication
is most helpful for the positive ones.
Most therapists agree that it
is difficult or impossible to do psychotherapy with a client
who is actively psychotic. Medication is the only currently
available mode of treatment for psychosis. Alternative methods
have been tried in the past, and although there has been some
success with these methods, the enormous expense involved
in maintaining a high ratio of personnel to patients has led
to the closing of the facilities where psychotic patients
were treated without medication. Currently, most patients
with psychosis are started on one of the newer SGA drugs.
Problems with these drugs are emerging, particularly weight-gain
and diabetes. Newer drugs are being developed and marketed
that claim to avoid these drawbacks.
Pain & Treatments of Pain
Reading: Chapter 8
I start this class with a discussion
of the treatment of pain, and how it presents many dilemmas
for the therapist. Complaints of pain are extremely common
among clients, and severe pain makes it difficult, and sometimes
impossible, for some to carry on with their normal life activities.
All of the treatments for pain have significant limitations.
Certain types of pain only respond
to drugs which are potentially addictive. These drugs usually
also cloud consciousness, another undesirable side-effect.
Even with these undesirable side-effects, most physicians
currently believe that there is no good reason to let someone
suffer from severe pain. The physician needs to work with
each patient to find the appropriate pain medication and dose
of medication for their specific type of pain. Withdrawal
from opiates, though extremely uncomfortable, is not life-threatening.
Reading: Chapter 9
The use of these mostly-illegal
compounds is widespread in the population of clients in the
20-40 age group. It is not my intention for this course to
judge whether the use of these compounds is either appropriate
or inappropriate, but rather to discuss what is known about
these drugs, and the possible benefits and dangers from using
them. This is always one of the most popular classes among
the students, and I usually learn something new from them
by the end of class.
Evidence exists that humans have
been experimenting with drugs that alter consciousness for
thousands of years. It is important for psychotherapists to
know about these various drugs, to be conscious of their own
biases, and to be able to work with each client in an open
and balanced way depending upon the specific circumstances
of that client's drug use.
Reading: Chapter 10
This is becoming an increasingly
important aspect of the psychotherapist’s practice.
I start off with demographic facts about the aging of the
population, and the resultant increase in the number of people
suffering from the dementias associated with aging. I make
sure the students know the meaning of the word “dementia”
and the difference between dementia and delirium, as there
is frequently confusion as to these terms. I say a bit about
what the current drugs can and cannot do, and how they work.
Currently a variety of different
types of pharmacotherapies to treat these disorders are being
investigated, though efficacy for many of them has not yet
been determined. To get a definitive diagnosis of Alzheimer’s
disease is difficult, except at autopsy, when the “plaques
and tangles” in the brain can be seen. This leads uncertainty
of diagnosis leads to many other areas of uncertainty that
the client (who is usually a family member, rather than the
person suffering from dementia) and their families, are dealing
with. In the later stages of the disease, the primary focus
for the psychotherapist is working with the families of the
patient who has dementia.
Supplements, Herbs & Oils
This is the final meeting of
the class, and the response to this topic is quite varied.
Some students want to believe that the alternative remedies
are the best to use for treatment of all disorders, while
others think they are mostly useless. The wide variety of
views allows students to become conscious of their biases.
This topic includes a wide range
of substances. Some of them, particularly the herbal remedies,
have been used for many years, while others have come into
more common usage only within the last ten years. At this
time, these products are not yet regulated by the FDA. This
means that testing for safety or efficacy is not required
before a product is put on the market. Some interactions with
other drugs have already been documented.
Summary of the Course
I make clear throughout the course
that since students are not prescribing medication, it is
not necessary for them to memorize drug names, side-effects,
or doses. They can look these up as needed for each client.
By the end of the course, I want the students to have an understanding
of which drug class might be appropriate for specific problems,
and which drugs might be problems for specific clients. I
encourage them to use the internet
for the most current information, and I advise them to look
up any drug, psychoactive or otherwise, that their client
is taking. I emphasize that they must pay attention to psychological
side-effects, and to any medical condition the client may
have, as these may be quite influential as to the client’s
life-view, plans for the future, or worries in the present.
As to their practices for providing optimal care for the clients
they may be seeing, I advise them to consult with me or other
therapists, if there are any questions that they are uncertain
about, or if they are insecure as to their judgements in assessing
a client. With psychopharmacology, as with everything else
in psychotherapy, the ethical concepts prevail: take good
notes and consult.
and Clients - by Padma Catell, PhD
This book is for anyone who is studying or practicing
the art of psychotherapy, particularly Marriage and
Family Therapists, Clinical Social Workers, nurses,
graduate students, school counselors, and psychologists-all
of whom have a need to know how prescription medications
and other psychoactive drugs affect their clients.
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