Medication, agency, and the drama we co-create
Published 25 March 2025
An elderly patient recently came in for a routine renewal of her chronic prescription for depression. The depression had improved, but now she was experiencing a constant anxious feeling. Two glasses of wine each night helped her cope. She requested medication to relieve the anxiety.
We had spoken about this before. She had already reduced her alcohol use. I could have written the prescription. It would have been easier, faster. But instead, I asked: What else might help?
We talked about breathing exercises. Meditation. Exercise. I expected hesitation, maybe resistance. Instead, she nodded. “I used to walk every morning - I think I’ll start again.”
In healthcare, these moments are crossroads. Many patients ask - some even insist - on prescriptions for anxiety and sleep. And in a system stretched thin, writing one often feels like the path of least resistance. But is it in their best interest?
The less travelled road is to engage with the patient to understand not only their need for relief but also the underlying causes of anxiety. And then to offer them alternative options for managing the anxiety.
A tool to make sense of this dilemma is using the framework of the Drama Triangle first proposed by Psychiatrist Stephen B. Karpman, the persecutor, the victim and the rescuer.
The Drama Triangle often plays out in the consultation:
The patient as the victim, external circumstances as the persecutor, and the doctor as the rescuer, offering medication as salvation.
This is the dilemma we often face:
• Do we become the rescuer, providing medication as a quick fix, reinforcing the idea that relief is external?
• Or do we step into the role of coach, guiding patients to engage with their anxiety differently, to develop agency?
The Empowerment Triangle, officially known as The Empowerment Dynamic (TED), is a “positive alternative” to the Drama Triangle proposed by business consultant and author David Emerald.
What if we stepped into the Empowerment Triangle instead?
• What if, instead of rescuing, we coached?
• What if, instead of assuming helplessness, we nurtured agency?
• What if anxiety wasn’t just a persecutor, but a challenger - an invitation to explore new ways of coping?
• What if, instead of fixing, we facilitated? What if we saw anxiety not just as something to eradicate, but as an opening for deeper engagement with life?
These conversations take longer. But they also hold the possibility of real change.