Case Examples

The Case of Ian – Part 1

Ian had been prescribed an antidepressant 14 years ago when he was signed off work following a ‘breakdown’. He had continued with the drug because he had been told that it would stop the ‘illness’ coming back. Somehow this was less shameful than admitting he could not cope with life and wanted to be taken care of for a while. There had never been any suggestion that he needed any therapy, or that a traumatic bereavement, breaking his leg and having to take weeks off work had anything to do with feeling depressed.

How Drugs Affect Thinking, Feelings and Behaviour


Drugs can affect people cognitively at each stage of perception, processing, consolidation and recall. For example, people given sedatives after bereavement may not be able to recall the events around the death and the funeral. Clients may find difficulty concentrating, or linking ideas both within a therapy session and at other times. They may also flit between ideas without really being able to reflect or go deeper. Sometimes, especially with antipsychotic drugs, clients may have difficulty retaining work done in therapy until the next session.


When clients are sedated, they may appear to be emotionally withdrawn or uninvolved. They may also be unable to re-experience feelings related to past events, describing events in a rather flat tone. Sometimes therapists may become aware that feelings of anger are suppressed or denied. Most drugs sometimes produce paradoxical effects so that the opposite effect is obtained. For example sedatives may make people excited and stimulants may make people depressed.


People may be passive both in their lives and in therapy, seeming to be unwilling to make changes. In one sense they might be seen to have handed over part of themselves for someone else to care for or fix. This might be observed both within the family dynamics, or in the relationship with health professionals. They may disengage from work, relationships and social activities. Conversely people may express obsessive ideas and demonstrate compulsive and repetitive actions. Sometimes they can be paradoxically irritable, aggressive or disinhibited.

Associated Issues

Drugs are often part of the problem in inhibited, protracted or unresolved grief, depression and agoraphobia. There is a close trilogy of issues between substance abuse, sexual abuse and eating disorders. One does not necessarily lead to another but where two are present, it is likely that the client or someone close to them has the third, so it is important to be alert to the possibility when conducting an assessment for therapy.