Working with the Medicine-Skeptical Patient: How Integrative Care Builds Trust and Collaboration
Most Psych NPs will encounter patients who feel uncertain about starting psychotropics. Sometimes it’s due to past side effects, family or cultural beliefs, or a strong desire to try other ("natural") approaches before considering medicines.
These conversations can feel tricky, especially when you genuinely believe medication might help. But these conversations can also be a powerful opportunity to build trust, strengthen the therapeutic alliance, and honor a care approach that centers the patient’s values.
Integrative care helps us meet patients where they are.
One of the core values in integrative psychiatry is acknowledging a person's unique lived experience, environment, priorities, and preferences. It's important to note that integrative care isn’t anti-medication. It doesn’t ask us to avoid evidence-based interventions. Integrative care invites us to use all our tools with more collaboration and intention.
Sometimes this means starting with foundations of good mental wellness: stabilizing sleep, improving nutrition, supporting nervous system regulation, or exploring inflammation and hormonal drivers. Other times, it means gently introducing the idea of medication, but in a way that respects the patient’s autonomy and pace (like a little sprinkle of Zoloft before getting up to a research dose).
Listening creates safety.
When a patient expresses hesitation, we can approach with curiosity and not persuasion in mind.
Even a simple reflection like, “It sounds like you’ve had some concerns about medication. Would you be open to sharing a little more about what’s coming up for you?” This can help the patient feel heard and understood. Patients need to know they’re part of the decision-making process and that we will take time to explain the reasoning behind any recommendation.
This spirit of collaboration is key. When patients feel safe in the therapeutic relationship, they’re more open to both integrative options and, when the time feels right, the possibility of medication.
They want to know they won’t be alone.
When it is appropriate to introduce a medication, reassurance is helpful. Something like, “If we decide together that a medication might help, I’ll be here to talk through it with you. We’ll take it slow, and we’ll adjust if anything doesn’t feel right.”
Remind patients that they don't have to do this alone, and it's ok to feel nervous.
Relational care creates better outcomes.
The Integrative Psych NP exists to help you help your patients. Sometimes the first step is building rapport, providing empathy, and creating the genuine connection. Ultimately, supporting a medication-averse patient isn’t about changing their mind. It’s about earning trust and remaining engaged.
Patients aren't the only ones who benefit, though. When we approach care more relationally we can experience a stronger connection and subsequently better outcomes from the trust that gets built.
