Mind-Body Medicine in Inpatient Psychiatry. David Låg Tomasi

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СКАЧАТЬ this professional represents a more mind-body perspective on the clinical treatment of the patient, whether as part of group sessions or individual psychotherapy. In any case, to account for the intrinsic complexity of diagnostic presentations on both Shepardson 3 and 6, each member of the Multidisciplinary Treatment Team in Inpatient Psychiatry plays a fundamental role in the delivery of the best possible care, as in the following scheme:

Degree Level4

Title5

Type of Degree

Multidisciplinary Treatment Team Member (yes/no)6

3

Doctors7

PhD

yes

      ↑

2

Pharmacists, Physicians/Psychiatrists, Psychologists/Psychotherapists, Social Workers8

MA/MD/MS9

yes

      ↑

1

Registered Nurses & Bachelor’s Level Clinicians10

BA/BS/BSN

yes

      ↑

N/A

Assistants, technicians11

AA/AAS/ADN

no

      ↑

N/A

Administrative staff/Management/Students/Volunteers/Interns12

AA/AAS/ADN or BA/BS/BSN

no13

      ↑

N/A

Support staff/Facilities14

AA/AAS/ADN or HS diploma/GED

no

      Finally, from the perspective of Psychotherapy in Inpatient Psychiatry, and more specifically psychotherapeutic interventions at the UVM Medical Center, it is fundamental to stress that on the Shepardson 3 (south) unit, most diagnosis and related clinical interventions focus on mood and personality disorders, in particular Bipolar Affective Disorder, Borderline personality Disorders as well as Major depressive Disorders. On the Shepardson 6 unit instead, the focus is on schizophrenia, schizoaffective disorders, as well as manic, psychotic, delusional presentations in general. Of course, there is a diagnostic overlap between the two units, resulting in patients being transferred from 3 to 6 and vice versa, based on specific clinical needs, although the acuity of presentations and relatively higher degree of involuntary admission is generally higher on Shepardson 6.

1.2 Therapeutic techniques

      a) Individual sessions

      The Psychotherapist/Group Therapist offers individual psychotherapy sessions to patients on both Inpatient Psychiatry Units Shepardson 3 and 6, as well as to patients throughout the hospital, especially in the Emergency and Medicine Departments, to meet the special needs of this type of population. Among the methods utilized in this context we find Cognitive Behavioral and Dialectic Behavioral Therapy to help patients identify cognitive distortions and improve their emotional and cognitive regulation, develop life and coping skills, better understand stressors and triggers and monitor vs/control their reactions. Problem-solving strategies are also at the center of group sessions such as the “Solve that Problem” and the “Wellness and Recovery Action Plan” developed by Mary Ellen Copeland (1997). Interpersonal Therapy techniques are also used to target communication skills and identify problems in relationships, while Psychodynamic therapy and counseling techniques are generally discussed in the form of basic theories and techniques in group sessions, and applied more in detail and with added focus during individual psychotherapy sessions, especially in the context of Posttraumatic stress disorder or other trauma-related psychological difficulties. These represents cornerstones of the psychotherapy-based interventions, an aspect discussed multiple times by therapist. In other words, since the Inpatient Psychiatry Units are “locked” units, the patient is brought to a deeper understanding of both challenges and opportunities for her/his healing process. If the patient might at times feel “closed in” “unable to relate to the external world,” “separated from family, friends, and opportunities,” she/he will also be “separated” from triggers, traumas, stressors, and even—another fundamental point in mind-body strategies—from addiction-related problems, such as specific temptations or external stimuli. Following the Therapist’s Perspective guidelines of the UVM Medical Center, these are the most important points followed in both clinical interventions and research study (Bancroft et al., 2014):

      1 Evidence of increase in awareness or insights on the part of the patient(s), coupled with increased hope. Measurement: Patient’s self-report in session reflects understanding of the concepts or principles under discussion. Hope may not always be a component.

      2 Patients fully participate in discussion and in whatever the directive of the group is. Measurement: Patients are attentive and engage in meaningful dialogue, complete associated worksheets or questionnaires.

      3 Patients being respectful and supportive of each other, offering their own insights from their experiences as a help to their peers. Measurement: Patients operate within the confines of group norms as given by the therapist, they respect the personal space of their peers, remain silent while others are speaking, they offer on-topic, reality-based supportive comments.

      4 There are few if any disruptions to group (i.e. staff needing to see a patient, or for a phone call/favors, patients with psychosis and disorganization). Measurement: Disruptions must not derail the continuity of the collective group process.

      5 Sense of community on the milieu. Measurement: Patient alliances and unit camaraderie are intrinsic to satisfying group experiences.

      Beside the organizational—teamwork perspectives discussed in the list above, there are many other essential task in the daily clinical work of Psychotherapists/Group Therapists. It is very important to note that, especially in the context of “Mind-Body Medicine strategies in Inpatient Psychiatry” the clinical intervention of a therapist covers the entire spectrum of activities and interactions on the unit. Thus, the clinical work starts with the solid preparation of evidence-based strategies for therapeutic sessions, continues with the meetings with the patients, and is monitored, controlled, and verified through electronic health records and clinical notes during the patient admission. Of course, to guarantee safety and privacy to each patient, the same level of attention and precision is required by every therapist also upon patient discharge. To explain all these aspects more in detail, we can refer to the list of Inpatient Psychiatry СКАЧАТЬ