Shea_Chapter 6

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CHAPTER 6 — The First Script

“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).