Why should a medically practitioner and therapist consider expanding their practices to include a mental health practitioner on-site?
Over the past twenty years there has been a move to combine mental health practitioners and medical practitioners/physical therapies within a primary-care setting. It is central to integrative medicine, which is “proactive” wellness and preventative healthcare. Integrative healthcare improves client care by treating the entire person and not just symptoms. This model has many treatment and health benefits and increases the ease of access to mental health and medical services.
Under historical models of medical specialization and the fractured relationships between psychotherapy and internal medicine, it is often difficult to bridge the gap between many of these services. Moreover, the divide between eastern and western medical methodologies has resulted in a reduced or less than acceptable outcome for patients and clients. Research suggests that between 50 and 90 percent of patients seek attention for mental issues from their primary care physician as opposed to seeking professional help from a psychotherapist (Brody, Khaliq, & Thompson, 1997; Burns, Wagner, Gaynes, Wells, & Schulberg, 2000; Hemmings, 2000).
Over the last twenty years research has found that more than 50% of patients seeking medical care also struggle with mental health needs. When these patients are referred by a Chiropractor or primary care physician only 10% will follow through with an appointment (Cummings, 1991; Aitken & Curtis, 2004). The research further indicates that most people admitted to emergency rooms for a physical trauma or illness also have mental illness and/or substance abuse issues. Tragically, Atiken & Curtis found that up to 76% of elderly suicide occurred by individuals who had visited their primary care physicians within one month of the suicide. These statistics suggests that clients and patients with mental health issues may not receive the proper treatment due to the specialist not being trained to practice outside of their area of expertise. Including psychotherapy in a primary care setting addresses this need.
Reciprocally, neither is a mental health provider trained to treat medical concerns their client is facing. These concerns exacerbate the client’s mental health or may be causative. These statistics, indicated above, would also apply in reverse. A high percentage of clients seeking attention for mental health issues also need medical care. With this potentiality it is important that every client who presents a mental health concern have a complete physical; or, at least, see his or her medical specialist.
When structural, neurological, and/or soft tissue systems have been impaired or traumatized it is important to understand how they impact the cognitions and emotions of the patient. Is it possible for a patient’s belief, state-of-mind, and cognitions to impact or impede the healing process for physical injuries or illness? Research undertaken by Burns (2010) found that in a collaborative environment psychotherapists are an asset to any medical practice. Pain is a primary indicator of how the body responds to injury. It also identifies what part of the body has potential internal injuries. When the brain communicates with the injured areas of the body that message generally is protective and calls for the muscles to guard against further injury or restrict mobility during the healing process.
At times, the patient is not able to differentiate between the pain resulting from the injury or the pain due to prolonged muscular stress and fatigue. Many patients will describe the pain they feel as moving from one area of the body to another. Other times they wonder why the duration of pain lasts longer, the frequency changes almost daily, and the intensity rises or falls for no apparent reason.
A Psychotherapist collaborates with medical practitioners to assist clients regain a(n) sense of control or active role in addressing the pain through Cognitive Therapy, Exposure Therapy, psychoeducation, or a newer therapeutic intervention entitled Eye Movement Desensitization and Reprocessing (EMDR). These techniques allow the patient to reduce or eliminate pain, muscular tension, and stress they bring to their appointment. It is very possible that these modalities accelerate the healing process, which increases the patient’s overall improvement.
EMDR has been proven to relax muscular tension prior to chiropractic manipulation, physical therapy, neuromuscular therapy and other medical interventions. Generally, it reduces the high levels of anxiety and stress related to any medical treatment (and least we forget it also assists in addressing issues such as disability, time off from work, financial, and relational strain) and/or “masking defense” (stress, tension, headaches, or the effects of trauma) the clients bring to their appointment.
The primary care physician, Chiropractor, physical therapist, and other medical practitioners are better able to target the injuries and not have to work through the masking defense. Since pain, mobility, and limitations plays a significant role in the healing process, the psychotherapist aids the chiropractor or medical practitioner by allowing the patient to regain a sense of control through reevaluating health beliefs, differentiating between a focus upon sickness or health, reframing the meaning of symptoms and pain, practicing new cognitions for coping, and better understanding the expectations of medical and counseling treatment.
Specific to dealing with accident injuries and trauma patients will seek treatment for physiological and structural concerns but often overlook the psychological implications of an injury. This has nothing to do with obvious brain trauma rather the effect on cognition and emotions regarding the patient’s sense of trust and safety. If left untreated, their thoughts and feelings related to feeling safe have been dramatically altered.
When cognitions and emotions are not addressed patients report feeling physical improvements, measured by improvements in range of motion and decreasing pain levels. However, they begin to report that adjustments do not hold or they feel good for a couple days only to have the symptoms return. When the psychological component is not addressed the brain patterning will return the body to the injured or compensatory state. The conflict is very simple, The medical practitioner works hard to correct the underlying problems with the physical structure; however, without addressing the clients cognitions and emotions, the clients mind keeps the body in protective mode and will not allow for complete healing.
When EMDR is integrated with structural corrections, clients report that chiropractic adjustment “lasts longer.” Also, when EMDR is performed prior to the chiropractic adjustment the general consensus from the patient is that the adjustment was easier. Both patient and doctor have reported marked changes with the integration of EMDR to the chiropractic manipulations. The integration of EMDR into the chiropractic practice accelerates patient improvement and makes the overall experience of chiropractic care more positive and productive.
There are differences and difficulties faced by medical and psychotherapy providers when attempting to blend different specialties into a collaborative team. Fortunately, they are primarily administrative. Insurance companies treat each of these professions differently (codes, approval procedures, duration for treatment, reporting procedures, and justification for future treatment). Other challenges, according to Burns (2010), are the differences in practice or protocol language, values, theoretical approach to practice, time constraints, and confidentiality issues.
Although there are difficulties, the benefits are worth the time it takes to integrate all providers and staff into a collaborative team. With patience on the part of medical providers and psychotherapists and a desire to fully integrate will produce a more productive and thorough healing environment for each patient and a long lasting benefit towards physical and mental wellness. As professionals, we can never forget that a satisfied patient is the best form of marketing any practice can desire.
Authored by Chris Waters, MA, MBA, LMHC, LPC, NCC is a Nationally Certified Counselor and Licensed Mental Health Counselor. He possesses a Masters of Arts degree in Psychology and Professional Counseling and an MBA in Global Leadership and Entrepreneurship. In collaboration with other providers, Chris’ relaxation techniques alleviate the stress and tension, which impedes recovery. With this technique the patient can experience an accelerated healing process. He specializes in Lifestyle Wellness and addressing the cognitive and emotive responses associated with: injury, stress, trauma, grief, loss, abuse, depression, anxiety, phobias, and addiction. He has researched and authored articles and books regarding: relationships, relational trust dynamics, economics and financial markets, investing, and resolving past emotional pain. addressing the cognitive and emotive responses associated with: injury, stress, trauma, grief, loss, abuse, depression, anxiety, phobias, and addiction.
Aikens, J. B., & Curtis, R. (2004). Integrated health care: Improving client care while providing opportunities for mental health counselors. Journal of Mental Health Counseling, 25, 321-331.
Brody, D. S., Khaliq, A. A., & Thompson, T. L. (1997). Patients’ perspectives on the management of emotional distress in primary care settings. Journal of General Internal Medicine, 12, 403-06.
Burns, B. J., Wagner, R. H., Gaynes, B. N., Wells, K. B., & Schulberg, H. C. (2000). General medical and specialty mental health service use for major depression. International Journal of Psychiatry and Medicine, 30, 127-143.
Cummings, N. (1991). Arguments for the financial efficacy of psychological services in health care settings. In J. J. Sweet, R. H. Rozensky, & S. M. Tovian (Eds.), Handbook of clinical psychology in medical settings. New York: Plenum.
Hemmings, A. (2000). A systematic review of the effectiveness of brief psychological therapies in primary health care. Families, Systems and Health, 18, 279-313.