Clinical

What does best practices mean when it comes to Mental Health treatment?

I believe some of us have spiritual emergencies which can be treated with psychotherapy alone or even with the support of a peer who has similar lived experience. I am also a therapist who knows when someone is in psychiatric crisis, either acute or the onset of chronic symptoms re-activating. What I don’t understand is: why this line is so misunderstood by practitioners?

The line I am referring to has been and continues to be outlined by the letter of the law and mental health laws in the US. These laws, for better or worse, make it as clear as day when someone is at immediate risk of serious harm to himself or others.  Upon crossing this metaphysical line in the clinical realm, these folks at risk of immediate harm need to be hospitalized and or assessed for further risk of harm. There really is no grey area here. To do otherwise is negligence. Of course, sometimes someone can be at risk of harming themselves, having a spiritual emergency, and still not require in-patient hospitalization or a psychiatric evaluation and observation. It doesn’t matter, though. When the risk is that high, we simply shouldn’t be gambling with life.

Self-harm is the act of deliberately inflicting pain and damage to your own body. Think about it: as therapists, we assess for risk all the time. If we are doing our jobs right and are truly person-centered, we should be using every technique in our toolkit to treat our patients where they are at regardless of how society views mental health diagnosis. Again, it doesn’t matter what the world believes a psychiatric label means in the context of providing therapy, that works and is the right fit for our clients in the context of their disorder and circumstance. However, somewhere along the way these new hot emerging trends in psychotherapy and peer work are being thrown around. They are the ‘in’ therapies, the hot new miracle modalities which are going to bring about better outcomes and are more humane.

Yet, when you break these new therapies down to their core theoretical underpinnings, they are no different, new or unique than what we already do as therapists. Unless you are grossly incompetent or were trained 50 years ago, who are these webinars and conferences for anyway? I just don’t get this hot fuss going around the practitioner community. Let me put it into greater context if it isn’t clear. I just read another training is being offered, this one called: ‘Making meaning from visions and voices: Supporting altered states’ in NYC. 

The theory behind this training is to provide therapy and services for patients and peers which support their so-called altered states, and understand that in some cases these seemingly difficult spaces for patients can be beneficial and powerfully creative having the potential to yield insight into their condition or particular circumstances. The trainings flyer makes it clear too that for some folks these situations can be quite disturbing and dangerous.

I seem to be unclear again as to what’s new here in terms of practicing person-centered therapy? Are trainings like this one and so many offered out there truly for the public and not geared or targeting clinicians at all? If so, which I believe, they should be targeting the public. They need to be clear that this is for the general public and everyone can benefit from attending. Otherwise, clinicians like myself will find themselves sitting at the same round table discussing the same techniques and theories from graduate school.

Maybe I am a brilliant clinician, or just maybe, I’ve taken the time to truly be person-centered, read a diagnosis for what it is, and apply my existing and ever broadening skill set to my patients and experience good outcomes without calling upon the buzz of a new acronym or miracle modality. I get it, we all do it, and want to talk about our skills in broad colorful strokes of positive regard, but we therapists should also be a little more humble, and learn our craft from the moment we commit to the helping process. Instead, we blame our shortcomings and inability to successfully treat our patients on our incomplete education of new terminology and the next, ‘in’ therapy.

Stigma is not just real – but is covert, overt and insidious. I have experienced it first hand. The public really needs to understand mental health diagnoses for what they are and not label and ridicule people with psychiatric disabilities. However, we really truly do need to do some homework and conduct new and authentic valid research before saying this or that therapy is going to change the way we practice in this field. Otherwise, you are just offering vapid and vacuous CEU (continuing education units) and mis-calibrating the message to those in the field that we really need to revamp the manner in which we practice and provide the work that truly be done for our patients or peers.

In terms of peer professionals, your self-awareness and insight into your disorder should be advancing research. Maybe the misperception or misunderstanding of what is really ‘new’ is my own. I really haven’t met too many people who have my diagnosis of schizophrenia and practice psychotherapy. But other people have had similar similar symptoms and have gone ahead and become practitioners too.

Maybe these people I am referencing have never vocalized there lived experience due to the same stigma I just talked about. If this is true then I suggest you need to be more open about your lived experience. As far as I am concerned, if you aren’t furthering the work that needs to be done, then you shouldn’t be in this profession which exists to help others. If you are holding back knowledge that can benefit others, why and how could you possibly profess to be helping them?

In order to truly help people the mental health community needs to better define what “help” means for people with a mental health disorder. We work in a multidisciplinary field rife with different approaches and different languages all targeting the same issue, treating mental illness or mitigating the impact of the disorder by providing a service to people in the public mental health system. Maybe this is the problem. By in large, practitioners are working in isolation at the micro level within a larger system of care. This is a bit counterintuitive to reform an already mixed up way of managing the entire way we do things in mental health.

In the end, there are so many different perspectives on what constitutes best practice in mental health treatment. So, what is and is not best practice will continue to be hotly contested until the the structure of the system is changed as well as what the system defines as common indicators of progress and what a good outcome is and is not. 

Thinking about progress is critical for both consumers and practitioners, as well as researchers and those with a vested interest in creating space in the field for creative pathways to empowering people with a diagnosis to be motivated in their recovery and truly track in their own terms, their success in treatment.

In therapeutic settings, therapists monitor the progress of their patients. This is done in several ways, depending on the type of therapy (for example, the modality, setting and treatment milieu) and needs to also be taught to consumers of treatment, so both practitioner and patient can work more closely and in greater clinical harmony.

For most therapists, in private practice, or in the public mental health system, there are already methods of tracking progress, without using complex, cumbersome, and expensive treatment modalities to implement and train staff.

But, ultimately, these measures, are clumsy and at times, disorganized approach to tracking recovery, and its converse, the over-intellectualized, ornate, and highly prescribed new, hip, modalities, which are so difficult to train with enough latitude to reach the mass base of practitioners, that identifying a common language to measure client and collateral reporting during interdisciplinary meetings, or even unidisciplinary collaboration becomes impossible and presents yet another impasse to treatment.

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