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CHAPTER 6 — The First Script
83
“You know, he’s the first damn doctor who ever listened to me.” Here we
have a nice example of a set of behaviorally defined interviewing
techniques
that have been woven together into an effective interviewing
strategy
for
enhancing the medication alliance while increasing medication interest.
For the Mini-Dose Recommendation to work effectively, several things
are worth noting. It seems to be important to “ask permission” at the end
of the technique, as reflected by my words, “What do you think?” because
such a question further reenforces our desire to work as a collaborative
team. Telling patients why we are recommending a low dose (as a response
to their concerns about being overly sensitive) is also important because it
conveys that we are not only carefully listening to the patient’s input but
also demonstrates that we are willing to act on it, a point not missed by
the patient.
In the above approach, we have seen our first example of a sequential
interviewing
strategy
. As you will recall from Chapter 2, interviewing strat-
egies occur when two or more specific interviewing
techniques
are serially
connected to achieve a set clinical goal. More specifically, if two or more
interviewing techniques can be used sequentially to achieve a specific
therapeutic goal more effectively, their order can be operationalized and the
sequence is given a name for ease of teaching and employment in clinical
practice (in this case, the pairing of the two interviewing techniques – the
Medication Sensitivity Inquiry and the Mini-Dose Recommendation – is
simply called the
Medication “Wary” Engagement Strategy
). I believe
that you may find the Medication “Wary” Engagement Strategy to be one of
your most effective strategies during an initial appointment for improving
medication interest and follow-through with your first new prescription.
I vividly remember a woman who had been suffering with a major
depressive episode for years, who had discontinued five consecutive
antidepressants “because I have had horrible side effects on those damn
things.” She had also been in ongoing psychotherapy with little relief. After
having applied the first technique (the Medication Sensitivity Inquiry) of
the Medication “Wary” Engagement Strategy, I employed the second tech-
nique, the Mini-Dose Recommendation (in this instance, at one-fourth the
typical starting dose). We gradually increased the dose over several months
at tiny amounts, and at her own pace, till we arrived at a therapeutic dos-
ing. Her depression went into a complete remission. Note that, even with
patients viewing themselves as overly sensitive to medications, with some
serious conditions it may be advantageous to start a medication at a typical
or higher-than-typical dose (Effective MIM approaches for such relatively
infrequent situations will be addressed later in the book).