8 Psychotherapy8.7 Psychotherapeutic psychiatry
8.7.8 Relational prescribing and deprescribing
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What relational prescribing means
Relational prescribing looks at how expectations, emotions and the clinical relationship shape decisions about medicines and what it is like to take them.
The pharmacotherapeutic alliance is the working partnership around a medicine. It includes trust, and agreement about what the medicine is for, the benefits to expect, its adverse effects, monitoring and review.
A patient may experience a prescription as care, validation, control or a sign of being dismissed. Ask what it means to them.
Reviewing an apparent treatment failure
When a medicine seems not to be working, explore each of these areas.
Area | What to explore |
|---|---|
Treatment adequacy | Diagnosis, indication, dose, duration and interactions |
Actual use | Missed doses, practical barriers and access |
Expectations | What the patient hoped would change, and fears about treatment |
Adverse effects | How much burden the patient feels, and how they interpret it |
Relationship | Disagreement, mistrust or pressure to provide a solution |
Non-adherence: explore it without blame. Separate practical difficulties from informed preferences or concerns.
Countertransference (the clinician's own emotional reactions to the patient) may show as pressure to rescue, reluctance to disappoint or irritation. Supervision helps you avoid prescribing as an emotional reaction.
Treatment resistance is not explained by psychology alone. Biological, diagnostic and treatment factors stay part of the reassessment.
Polypharmacy and withdrawal
A medication review sets out the indication, benefit and harm of each medicine. Look for drugs continued after an earlier crisis that no longer have a current purpose.
Plan deprescribing (reducing or stopping medicines) together with the patient. Explain that stopping a medicine does not mean withdrawing care.
Withdrawal symptoms can be mistaken for relapse. Assess their timing, their character and how they respond to changes in the reduction schedule.
Dependence-forming medicines and antidepressants usually need a gradual, individualised reduction with review and support, rather than abrupt stopping.
Agree a shared plan. It should name the responsible prescriber, the review arrangements and how concerns will be dealt with between appointments.