Systems of Care: Viewing People Through an Integrated Lens
Anyone who has stepped into a meeting with a doctor can attest to a degree of heightened anxiety and wariness. What tests need to be run? What are the results? How will my family and friends react? What does this mean for my life? It’s that last question which eventually seeps into the conscious eye and becomes dominant. Whether the diagnosis is allergies, a broken bone or cancer, the “I” of our personal stories inevitably comes back to center. Unfortunately, there is often nobody there to discuss such things. For that, many of us will turn to a therapeutic professional, but even here there’s a catch; often these professionals know little about the medical side of life and even less about how medical issues may contribute to or even largely define the mental/emotional difficulty currently being experienced.
To address these problems, “integral care” is the current hot topic, a profoundly large structural change to how medical and psychological care is provided. While there are many models being used to put this into practice, the focus here will be on the underlying theoretical bases. For some, this focus may immediately set off concerns of delving into airy, unrealistic, ivory-tower musings. I assure you, this is not a mere academic exercise.
Consider the shift in how drug and alcohol addiction has been treated over the last few decades. Initially thought to be fully understood as a moral failing, science has brought us a broader understanding of the genetic and biological variables, leading to greater acceptance and a lessening of shame. Think also of the prevalence of psychotropic drugs. While debates exist (and should exist) about their proper usage, there is no doubt that for a great many people, these drugs are the difference between a functional life and one of debilitating emotional/cognitive difficulties.
I was recently at a seminar concerning stress-resiliency. There it was noted caffeine has a half-life of 5-6 hours and any amount still in the system can disrupt the body’s ability to go into and stay in deep sleep, the only part of sleeping that is rejuvenating (Preston, 2016). An example was given of a patient who came in for treatment following twenty years of dealing with depression and treatment through various drugs, without a positive outcome. A questionnaire was given concerning caffeine intake, where it was found the man was drinking the equivalent of 13 cups of coffee a day and had been doing so for decades. Over the course of nearly three months, the caffeine was slowly lowered and the result was a near complete removal of depression as sleep became normalized.
Other examples abound, all of them having to do with the intimate connection between body and mind. I will add a third component, relationship. In Daniel Siegel’s work Interpersonal Neurobiology: “Our mental lives are profoundly relational. The interactions we have with each other shape our mental world” (Siegel, 2012, 04-02). Consider that without the relational connection of the doctor and patient in the above example, the solution would not have been found. Information flows within, between and through the body and mind, but it manifests in the world through relationship dynamics.
Without a theoretical foundation allowing for the integration of body and mind (and relationship), the profoundly unhelpful distancing between the medical and psychological fields will continue. This is not a situation where simplistic declarations of “mind over matter” will suffice. We are not disparate parts, but integrated wholes.
Two examples for integrating medical and psychological practices are “Functional Medicine” and “Neurocounseling.”
A fuller description by Dr. Will Cole can be found here, with two of the principles provided:
- Functional Medicine views us all as being different; genetically and biochemically unique. This personalized health care treats the individual, not the disease.
- Health is not just the absence of disease, but a state of immense vitality.
As with any theory, the way it is utilized in practice can be vary in degrees of legitimacy. When moving from a restrictive theory of practice, sometimes the next step is to flail about in the new freedom found. There is much discussion and debate ongoing, but important progress is still being made. Treating people as whole persons, not just repositories of particular diseases can help humanize medical experiences. Looking at a good life as not necessarily being absent of suffering, but how it provides the space for change and energetic movement, can help people expand how they express themselves.
“…bridges the disciplines of counseling and functional medicine by combining physiology, the brain, neurosteroids and behaviors to create a synergy that is more effective than their individual parts” (Russell-Chapin). Benefits include:
- Integration of neurocounseling provides additional insight into the physiological basis of interpersonal and therapeutic relationships.
- Neurocounseling offers clients a fuller opportunity for personal wellness and intrinsic locus of control through the practice of emotional and physiological self-regulation.
Under the umbrella of neurocounseling, therapists can join with medical doctors, pharmacists and dietitians to treat the whole person. Depression and suicidal ideation can be connected to thyroid problems. Exercise and the types of food eaten help control the types and amounts of neurochemicals being released in the nervous system, leading to variations in mood and thought. Sometimes simply knowing the structure and function of the brain can lead to a greater appreciation for one’s struggles with emotions and particular experiences. Biofeedback and mindfulness practices can help with a variety of emotional difficulties and empower people to accept, monitor and regulate their inner lives.
Where to Go From Here
Therapy is first and foremost about meeting the client where they are at. By bridging the gap between the mind and body, by drawing attention to the relationships within and through which we live, therapy can continue to help hold the whole person while moving forward with greater understanding and acceptance.
© David Teachout
Preston, John D. February 2016. The Habits of Stress-Resilient People. Institute for Brain Potential.
Russell-Chapin, Lori A. Neurocounseling and functional medicine: How understanding neurosteroids complements our counseling strategies. Counseling Today. January 2016, Volume 58/Number 7.
Siegel, Daniel J. (2012-04-26). The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are (p. 15). Guilford Publications. Kindle Edition.
Siegel, Daniel J. (2012-04-02). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind (Norton Series on Interpersonal Neurobiology) . Norton. Kindle Edition.