An exploration of how therapists view therapeutic process in relation to clients who are taking benzodiazepines
This qualitative inquiry explores how therapists view therapeutic process in relation to clients who are taking benzodiazepines. Benzodiazepines are drugs prescribed for the short term relief of the symptoms of anxiety and for insomnia. There are estimated to be over one million people dependent on benzodiazepines in the United Kingdom at present. I conducted a survey of a sample of NHS psychotherapy services in England to ask what their policies were towards clients in therapy who also took benzodiazepines. I then conducted semi-structured interviews and audio-recorded twenty-six therapists from different therapeutic orientations, with experience of working with clients taking benzodiazepines in a variety of settings. I analysed these interviews using grounded theory, deriving forty-four propositions from the data. I was specifically interested in the process of grieving and I propose that benzodiazepines suppress emotional processing and affect narrative competence in relation to grieving, which is thereby inhibited, prolonged or unresolved. I also identified that clients seemed to suffer a loss of lived experience for the time they were taking this medication. When comparing clients taking benzodiazepines with other clients, therapists needed to make adjustments to the therapeutic process because these clients were less able to respond to therapy. Psychodynamically, I propose that there might be a series of triangular relationships between client, therapist, drug and doctor, involving dependency, power, seduction and ingratiation. Because the client's defences seem to be increased by benzodiazepine use, I suggest that their use might be incompatible with psychotherapy. Therapists confirmed the survey's findings that the implications of benzodiazepine prescribing for clients in therapy are largely ignored and we make some recommendations that psychotropic medication issues be given greater prominence in the training and supervision of therapists.