When people meet each other, we make each other. When we prescribe a medication, we prescribe each other. We can do it better.
We can create better therapeutic alliances when prescribing (and de-prescribing) medications for people with mental illness. In Prescribing Together, my friend Warren Kinghorn and I interviewed clinicians who study and practice how to prescribe together. Writing this book, we learned from Francine Conway how to mentalize, from Sidney Hankerson how to connect with community, from Sharon Inouye how to listen stories, from Sarah Fineberg to deprescribe, and many more.
We are honored to share their collected wisdom. They all care about the usual metrics– pharmacokinetics, formulations, doses– but even more about the relationships that can be formed.
Those relationships are sometimes called working alliances. Working alliances have three features: goal, task, bond. The goal is the “why” of treatment, what the patient and clinician are working towards, whether it be recovery or remission. The task is the “what” of treatment, the activities which a patient recognizes as essential for their health, whether they be thought records or titration schedules. The bond is the “how” of treatment, the affective relationship which develops between clinician and patient, whether it be consulting or caretaking.
A clinician’s ability to form these alliances profoundly influences the efficacy of their labor for the patient, as well as their satisfaction with and resilience in the work of caring for persons with mental illness.