Mind-Body Medicine in Inpatient Psychiatry. David Låg Tomasi

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СКАЧАТЬ or instruction, such as learning to make friends, to handle social situations, to do laundry, and to develop community awareness, or interactions of employees or contracted individuals with clients whose job description or contract specifications do not specifically mention “psychotherapy” as a job responsibility or duty. (Added (1987), No. 245 (Adj. Sess.), § 1; amended (1989), No. 250 (Adj. Sess.), § 4(b), (d); (1993), No. 98, § 8; (1993), No. 222 (Adj. Sess.), § 9; 1997, No. 40, § 50; 1997, No. 145 (Adj. Sess.), § 22; 2013, No. 96 (Adj. Sess.), § 177.)” (State of Vermont Board of Mental Health, 2017).

Psychotherapy thus involves evaluation, diagnosis, counseling, and treatment with a special focus on the relationship, rapport and dialogue with the patient. In this sense, psychotherapy is truly a form of “talk therapy” as separated (albeit not necessarily “opposed to”) psychiatry, which generally involves pharmacological interventions. In this sense, this discipline is truly at the center of both psychology (especially clinical psychology) and psychiatry. Although the clinical and legal rules and regulations, including training, supervision or internship vary significantly from country to country, the focus of psychotherapy is on helping the individual (in individual, private, one-to-one sessions) or the group (group psychotherapy) in various areas of his psycho-physical wellbeing via clinical application of theories, and methods from psychological science. Since the term combines ψυχή and θεραπεία, this discipline is an integral part of medical treatments based on medical-psychological science, neuroscience, theories and methods from behavioral medicine and positive psychology, and improvement strategies for patient-provider interaction and therapeutic alliance. As previously mentioned in the Introduction and in Chapter 1, the title and role of an inpatient psychiatry psychotherapist/group therapist has changed dramatically over the years. As this analysis is trying to illustrate, the changes occurred in the 5-year period 2012–2017 have been the most positive, with a dramatic amelioration following the modification to the implementation occurred in 2014, which, albeit for a short time, interrupted this positive trend. These were also some of the most productive years for the hospital as a whole, with the University of Vermont Medical Center (former Fletcher Allen Health Care) awarded U.S. News & World Report “Best Regional Hospital” for the 4th Consecutive Year in 2014–20151, and “Top ten” among university hospitals participating in the annual University HealthSystem Consortium (UHC) study, for providing safe patient care in 2013, and remaining in the top ranks until the end of 20152. In the Inpatient Psychiatry Unit, the professional figure of psychotherapist has changed in five main phases: 1. Recreational therapist, 2. Occupational therapist, 3. Activity therapist, 4. Group therapist, and 5. Psychotherapist. While each professional figures represent a well-defined area of clinical intervention in the therapeutic sense, the general direction of the changes of this figures moved from a more leisure-based, recovery and general well-being intervention, to a full clinical psychotherapeutic form of intervention which involved all the parameters listed above in the State of Vermont definition of psychotherapy. While this title was fully implemented (internally, by the hospital, as it was always a legislative requirement for all rostered practitioners) only in 2014, the full therapeutic and clinical-diagnostic evaluation characteristics of this profession were already in place in 2010–2012. More specifically, the clinical evaluation/psychological assessment of group therapists/psychotherapist since these years follows the structure below:

      Patient personal information/identifiers:

      Medical Record Number/Code

      Date of Birth

      Current Age

      Date Service Provided

      Multidisciplinary Treatment Team Providers (Psychiatrist/Psycho­therapist/Doctor)

      Primary Medical/Psychiatric Issue vs. Chief Complaint and Reason for Referral

      Diagnosis (Psychiatric/General-Medical):

      Discussed with the rest of the Multidisciplinary Treatment Team (in the case of relevant direct clinical notes vs. HPI/collateral information, the name of the clinician, whether doctor, psychiatrist or psychotherapist, is also reported) it maintains the DSM-IV-TR Multi-axial system even after the 2013 changes of the DSM-V:

       Axis I: All psychological diagnostic categories except intellectual disability and personality disorder

       Axis II: Personality disorders and intellectual disability

       Axis III: General medical condition; acute medical conditions and physical disorders

       Axis IV: Psychosocial and environmental factors contributing to the disorder

       Axis V: Global Assessment of Functioning

      Axis IV and V are further described in a separate clinical narrative, which includes:

       Current Activities of Daily/Weekly Living

       Job/Vocational Activities

       Special Interests/Leisure/Recreation

       Volunteer Activity

      Group Therapy/Psychotherapy Assessment

      More specific to this professional figure, this area of the psychotherapist’s assessment focuses on the following aspects:

       Strengths & Skills/Presentation: The psychotherapist evaluates specific observed vs. self-reported characteristics, including Current Functioning, Orientation, Appearance/Per­sonal Hygiene, and Eye Contact.

       Patient’s Goals for Admission: This section examines the patient’s perspective on the current admission, and is inclusive of the primary area of concern (self-reported vs. observed or based on HPI/collateral information/previous admissions)

       Special Needs or Challenges: Beyond referring to the psychiatric HPI, this section focuses on mental/medical problems and/or comorbidities, as well as patient’s preferences (from general medical history and review of records/psychological testing, Present Illness, Psychiatric Review of Systems, Psychiatric Treatment History, Substance Abuse History, Family History, Developmental and Social History, Sexual History, Medical/Surgical History, Mental Status Examination, to allergies, intolerances or patient-specific special needs, such as sensitivity to specific audio-visual stimuli or environmental elements)

       Assessment: The full psychotherapeutic assessment of the patient, on the base of direct evaluation and collateral/HPI-based information, inclusive of suicidal/homicidal ideation/intent, somatic presentation, insight, intelligence, memory/cognition, and mood/affect.

       Plan: The psychotherapist evaluates specific individual or group psychotherapy sessions and other therapeutic activities, to provide an individualized, patient-centered therapeutic modality for the current admission. The plan is updated every week (generally on Wednesday evening/Thursday after morning rounds) to evaluate current psychological data, as well as to work towards future discharge plans and outpatient therapy, in collaboration with the Multidisciplinary Treatment Team.

The Group Therapist/Psychotherapist thus directly interacts with the Multidisciplinary Treatment Team to provide an integrated/integrative form of therapy, with a special focus on individualized medicine and patient-centered clinical approach. While the psychotherapist’s job also involves support and supervision of other professionals in the teamСКАЧАТЬ