The roles of the integrative mental health provider

By Julie Luzarraga

Practicing in an integrative setting as a mental health provider requires the practitioner to diversify their skill set and develop flexibility in how we work with patients. In one day, an integrative mental health provider may lead group education and support to patients living with stress-related illnesses, work with a patient experiencing a depressive disorder, or offer support to another therapist who is experiencing some symptoms of secondary trauma from her work with survivors of abuse. We are required to wear many different hats.

A mental health provider is a valuable resource for patients and their care providers. One in five adults live with a mental illness. According to a 2017 study, 42 percent of adults in America have seen a mental health provider at some point in their lives, and 39 percent were referred by their medical provider. Many providers find referring patients to mental health therapists a positive addition to their patient care team, but most do not fully understand all how a mental health provider can contribute.

The most common role of a mental health therapist is to provide traditional talk therapy in an individual setting.  While individual talk therapy is an effective intervention with a variety of treatment approaches, integrative mental health therapists provide of variety of other functions beneficial to the patient and the integrative healthcare team.

As I’ve previously written on in Integrative Practitioner, a mental health provider practicing as an integrative practitioner has additional training in primary health education, integrative and complementary therapies, mindfulness and stress reduction skills, and the emotional intelligence to work collaboratively with the integrative medical team. Integrative mental health providers may be licensed counseling professionals, licensed social workers, licensed marriage and family therapists, or licensed psychologists who practice within the integrative healthcare setting, in a hospital or agency setting, or privately. Depending on the patient’s clinical presentation, the integrative healthcare team’s needs, and the provider’s scope, integrative mental health therapists may take on differing roles on the team.

Treating provider.

The most common role for the integrative mental health provider is traditional talk therapy or psychotherapy. Psychotherapy is an effective treatment approach for depression and anxiety disorders alone and in conjunction with pharmacotherapy. Different approaches are used based on the patient and their unique circumstances and diagnoses.

Cognitive behavioral therapy (CBT), motivational interviewing, eye movement desensitizing and reprocessing (EMDR), mindfulness-based therapy, and dialectical behavior therapy (DBT) are some of the techniques mental health providers will use when working with patients.  Some patients may also benefit from couples’ therapy, family therapy, or group therapy. When integrative healthcare providers assess a patients’ whole health, including relationships, spirituality, stress, work satisfaction, and overall happiness, it is common for patients to identify some level of distress. If distress or concern is identified talk therapy is an appropriate referral.

Assessment and Diagnosis

Patients with physical disease, especially chronic illnesses, can have complex symptoms that may warrant the need to tease out any comorbid mental health conditions.  Conditions such as diabetes, heart disease, fibromyalgia, chronic fatigue, and any chronic pain frequently exist with anxiety or depression.  Understanding the significance of the mental health symptoms and whether they are primary or secondary to the chronic illness can influence treatment approaches and medication choices.  Furthermore, many mental health conditions such as complex mood disorders, adult attention deficit hyperactivity disorder, obsessive compulsive disorder, and post-traumatic stress disorder require the expertise of a mental health provider for a thorough differential diagnosis.  Mental health providers will frequently see patients who have been incorrectly diagnosed and not progressing in treatment because of it.  Psychological and neuropsychological testing are also helpful in establishing the correct diagnoses.

Education and Support

Because therapists typically see patients on a more regular basis, they are in a prime position to provide continued education and support about any medical conditions and health behavior interventions.  Integrative mental health therapists can partner with medical providers in developing realistic treatment plans, making adjustments, and assessing progress. This is particularly beneficial for chronic illnesses.

Stacy is a 59-year-old woman who I have seen for many years for anxiety. She also sees a psychiatric nurse practitioner, a medical provider, and occasionally attends meditation classes.  She was recently diagnosed with fibromyalgia and given information on changing her diet and adding more movement to her daily routine. She is a high-functioning professional who prides herself on her intelligence. Part of her anxiety is fearing disappointing people or being seen as weak.

When her medical provider presented her with this new information, she appeared calm and committed to making all of the changes as soon as she got home. When I saw her later in the week, she was anxious, felt guilty, and had not even read the material her provider had given her. She couldn’t remember what her medical provider has said to her. Her look of calm was actually her freezing after feeling flooded with anxiety and information. 

Her anxiety was making it difficult for her to focus and she was fearful of becoming incapable of the travel she so enjoyed. The three providers met to discuss what would be realistic treatment goals given her anxiety. We also decided to bring in a yoga therapist who could work with her individually so Stacy could experience mastering some of the postures.  That mastery would help Stacy feel empowered and more confident in taking other steps.  Understanding Stacy’s anxiety shaped how we structured the plan and goals as well as the interventions.  Had we not considered her anxiety, she may never have been able to get past the overwhelming feelings she initially experienced. 

Integrative mental health therapists are able to assess a patient’s capacity and readiness for change. There may be a standard protocol for an autoimmune diet, but each patient will be in a different place regarding their readiness and ability to make changes. The integrative mental health provider can assess the patient’s resources and help develop a plan in which the patient can succeed. Education and support may also come in the form of a support group or shared medical appointments co-facilitated with an integrative mental health professional. 

Crisis Support

Though not often, patients do present with mental health crises. This may be disclosing some thoughts of suicide or self-harm or facing the crisis of a sudden loss or being the victim of a violent crime. In these situations, it can be invaluable to have access to an integrative mental health therapist who can quickly assess the severity of symptoms as well as develop a short-term crisis plan and help with any triage needed. 

Team Support

Finally, the integrative mental health therapist often organically provides support and education to the integrative healthcare team. A 2014 research study found over half of physicians report at least one indicator of burnout. Integrative mental health providers are specifically trained in teaching and practicing stress-reduction techniques, which often get shared with colleagues.  They are also valuable resources for processing experiences of secondary trauma and compassion fatigue as well as mitigating other stress-related dynamics occurring in the team. While integrative mental health providers cannot provide treatment for their colleagues, they can be a credible source of information, tools, and further guidance. 

References

Barna Group (2017).  Americans Feel Good About Counseling. Research Releases in Culture & Media. Retrieved from https://www.barna.com/research/americans-feel-good-counseling/.

Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.T., Reynolds, C.F. (June, 2013).  The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons.  World Psychiatry.  12(2):137-48.

Kamenov, K., Twomey, C., Cabello, M., Prina, A.M., Ayuso-Mateos, J.L.  (February, 2017). The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis.  Psychological Medicine.  47(3): 414–425

Luzarraga, J. (2018).  What makes a mental health provider an integrative practitioner? Integrative Practitioner.

National Institute of Mental Health (2019).  Mental Illness.  Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml.

Shanafelt, T.D., Hasan, O. Dyrbye, L.N., Sinsky, C., Satele, D., Sloan, J., West, C. (2014).  Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.  Mayo Clinic Proceedings, Vol. 91, Issue 2.