The value of an integrative approach for mental health providers

Photo Cred: Paweł Czerwiński/Unsplash

By Julie Luzarraga

As much as western medicine has historically separated the body from the mind, psychology has also isolated the mind from the physical body. Even in my social work training, which emphasized a holistic approach, the impact of physical health on emotional wellbeing and mental health diagnosis received little attention. The distinction between a medical social worker or psychologist and a clinical social worker or psychologist is an example of how we continue to separate all areas of health. 

Applying the integrative health lens to the practice of mental health creates a richer understanding of our patients and their unique presentation of symptoms, more treatment options, and greater choice and volition for patients.

While covered to some extent in most mental health programs, incorporating a patient’s physical health into the initial assessment tends to get overlooked by most mental health providers. For many mental health providers, inquiring about a patient’s physical health has become a question asked mainly to meet documentation requirements. Yet, the impact of physical health and illness, including many commonly prescribed medications and supplements, can have a significant impact on a person’s mental health. Without paying close attention to these interactions both the patient and provider can get stuck going down a less effective treatment path. 

Case Study 1

Cathy is a patient who came to therapy after feeling depressed and irritable for several months. Having just turned 45 years old, she felt it was a “mid-life crisis” causing her symptoms. During the initial assessment, she reported that she had no other health concerns and was active, exercising regularly, and eating a healthy diet. She focused mostly on her irritability combined with lack of desire to do much, including being intimate with her husband. 

After assessing for any suicidality or history of trauma, which Cathy denied, we began to discuss goals and different approaches. I initially thought about using a psychodynamic approach to meet her level of insight and expressed desire to investigate interpersonal dynamics. While this would have been a good approach, and was something I did weave into her treatment, we were still missing something.

As I began to explore Cathy’s family history, she mentioned a history of hypertension in her family. She had not previously disclosed that she was living with hypertension, stating she was “healthy” when I asked about her overall health. But now I was hearing something different.

Cathy had been recently diagnosed with hypertension and was currently taking a beta blocker.  As we discussed this further, it was clear her symptoms began around the same time she had started her current medication, which has a potential side effect of dampening mood.  While there were certainly interpersonal issues and life stressors, the fact that Cathy was living with hypertension was an important piece to her assessment and treatment planning.

The first step we took was to collaborate with her primary healthcare provider who was prescribing her medication. Collaboration between providers is essential when practicing integrative healthcare. One of the challenges integrative healthcare providers face is how to work within one’s professional scope while also incorporating other disciplines. In speaking with her primary care provider, I was able to share information on how Cathy’s stress and emotional issues may be influencing her blood pressure while her primary care provider helped me understand the side effects and course needed to find the right for Cathy’s condition.

Cathy and I adapted her treatment plan to include learning and practicing stress-reduction skills as well as delving into the interpersonal issues she felt were also impacting her mood. Cathy’s situation is a solid reminder for mental health providers to dig further into a patient’s physical health even when they present as healthy. We can be healthy and still live with conditions that may have a significant impact on our mood. 

Including Cathy’s presentation of depressive symptoms, there are several psychological conditions integrative approaches are particularly helpful with. Chronic pain conditions frequently accompany depression and complicated grief and trauma are often felt in the body almost as much as in our emotions. These conditions are often a complicated web of symptoms intricately connected in some way. Without the use of an integrative lens, mental health providers can miss large pieces of the presenting issue and potential treatment options. 

Case Study 2

Mary is a patient in our clinic who lives with post-traumatic stress disorder, is a survivor of breast cancer, and struggles with fibromyalgia. There are times when we are unclear whether her pain, fatigue, or other symptoms are physical or psychological in origin, but we work together as a team to help her move through the pain and build her resilience. One of the benefits of working closely with her other providers is that we can provide the least restrictive model of care for her. She is empowered to guide her treatment.

Recently, she has made a goal to discontinue one of her medications that we all feel is likely negatively impacting her mood and sleep. She was able to choose to start working on this, which in turn adjusted what she and I worked in treatment. We backed off from any heavy processing of her childhood trauma and began to focus on relaxation skills to support titrating off the medication. She increased her time with bodywork and decreased therapy time, which helped her to feel less overwhelmed. 

If I were treating her without an integrative lens, I could have seen her desire to decrease sessions as defensiveness or unwillingness to do the work. Through an integrative lens, I can support her decision to focus on one area at a time, validate the importance of that, and be part of empowering her to make decisions about her healthcare.

Applying an integrative healthcare lens to mental health is more than asking about physical health and diet. The holistic view and integration of other approaches broadens the assessment field. The benefits are increased collaboration and knowledge of your patient, which will result in a richer and more effective treatment plan.