How therapists can talk to clients about medication while staying within their scope of practice: Lessons from the Lindsay Clancy trial

This is part 3 of a 3-part series for mental health therapists and their supervisors. I am a Registered Psychotherapist in Ontario, Canada and have been practicing for 20+ years. I have an active supervision practice and the topic of the Lindsay Clancy trial is coming up in most of my supervision sessions. This series represents my attempt to clarify the issues relevant to Psychotherapists and provide my perspective on how Psychotherapists can mindfully improve their practice while staying out of the anxiety loops that a trial like this can cause for professionals. My perspective reflects the role and scope of Registered Psychotherapists in Ontario and may not apply directly to other jurisdictions.

-Carly Fleming, M.Ed., RP

Court testimony in the Lindsay Clancy trial has described a treatment course involving more than a dozen medications prescribed across several providers in the months before the deaths of her three children. In Ontario, medications for psychiatric illness must be prescribed by a medical doctor or nurse practitioner. But as therapists, we often find ourselves sitting across from a client who is struggling with a medication regimen that isn't working, side effects they don't understand, a doctor they only see for ten minutes every few months (at most) - and asks some version of, "What do you think I should do?". In supervision I have been talking to therapists lately who are more concerned than ever about how to navigate these conversations, in light of the high profile nature of the Lindsay Clancy case.

The reality is that in Ontario, and in most jurisdictions, the honest answer to that question is “I can't tell you”. Diagnosing and prescribing are outside a psychotherapist's scope and wading into advice about how to manage medications comes dangerously close to crossing this very important boundary. But "I can't tell you" is not the same as "there's nothing I can do." There's important space between 'I can't tell you' and leaving a client to feel unsupported and alone – and it is within that space where you therapeutic skills can have a true impact.     

Things you should stay away from weighing in on

- Offering an opinion on whether a specific medication is right for them

- Suggesting they start, stop, or change a dose

- Speculating about whether a symptom is a side effect versus something else clinical

- Recommending they push for a particular diagnosis so they can access a particular medication

How you’re able to help

Therapists are in a unique position to fill a major gap in the way that most medical systems treat clients – therapists can help clients learn how to advocate for their own care. This may be as simple as reminding them that they can (and should) follow up with their doctor if there’s something happening that they don’t understand. Or it can look like helping them prepare so that when they show up to their five-minute or fifteen-minute doctor’s appointment they are prepared, rather than walking in and being asked "how are you feeling" and saying "fine" because that's what comes out under pressure.

Practically, that can look like:

• Helping them track symptoms, sleep, mood shifts, or side effects between sessions, so they have specifics instead of a vague sense of "not great"

• Helping them write down the two or three things they most want to raise before they walk into the appointment, so it doesn't get lost

• Helping them notice patterns you're seeing across sessions that they might not have connected themselves - described back to them as an observation, not a diagnosis, for them to decide whether it's useful to raise

• Normalizing that it's okay to ask a doctor to explain a change, or to ask for more time, or to get a second opinion when something feels off

This reframes your role from "advisor who has to stay silent" to "advocacy advisor” which is both accurate to your scope and uniquely valuable to a client navigating a system they usually understand far less than you do.

And then you document it

Everything above - what the client raised, what you didn't offer an opinion on, how you redirected, what you helped them prepare for their medical appointment - belongs in your notes. This is the direct continuation of the point from the last post in this series: the thinking behind how you chose to navigate a medication conversation is always worth documenting, as it illustrates your professional competency and helps support the ongoing therapy plan.

A note that simply says "discussed medication concerns" tells a supervisor or reviewer almost nothing. A note that says client raised concerns about medication side effects; redirected to physician; helped client prepare questions for upcoming appointment; no clinical opinion offered on medication itself tells a complete story - what came up, what you did, and why. This is the approach to documentation that protects your client's care and your own practice if this case is ever revisited.

Why this matters beyond any one case

Whatever the jury decides about Lindsay Clancy, her case has already highlighted something therapists face every day: mental health medication management is often fragmented, fast-moving, and hard for clients to navigate. Therapists aren't the ones prescribing in this picture. But we're very often the ones sitting with the person trying to make sense of it, and how we handle that role - clearly, within scope, and well documented – is how we can best support and empower our clients while protecting ourselves and our profession.