Which Tool When? (Written for Psychiatrists- but you can read it!)

We collaborate with the patient to set treatment goals and outline a roadmap to achieve them. In addition to medication management and psychotherapy that we may offer in our practice, there are many other resources available to augment and enhance our treatment plan. As Psychiatrists we’re in the best position to coordinate treatment and draw connections for the patient between their symptoms, goals, and available methods.

Our “black bag” consists mainly of psychiatric diagnostic and treatment formulation tools, as well as various psychotropic medications and perhaps psychotherapies that we may prescribe. In sessions with us, among other benefits, patients can learn to manage medications, to understand and communicate their emotions, to develop trust, attachment to and separation from other human beings.

In addition to what we offer in our practice we consider referrals for physical evaluation, couples, family, and/or group therapies. As I’ve described in previous articles, many useful resources are available such as books, CD’s, websites and podcasts to augment what we’re trying to do. We may also recommend lifestyle modifications such as journaling, exercise, diet change, Yoga or meditation, regular social activities, or taking up hobbies and creative activities. Our treatment recommendations, whether they involve chemicals or not, are prescriptions for our patient’s illness and deserve adequate time for reinforcement.

I believe that Mindfulness Training (MFT) is an important part of almost any treatment plan. Whether we are treating anxiety, affective, cognitive, or post-traumatic stress disorders, incorporating MFT into the roadmap, and perhaps basing the roadmap on MFT, has the following advantages:

The patient learns

  • how to be in the present, recognize when out of present, and get back again.
  • how to recognize and “shift” out of automatic patterns to a more adaptive approach.
  • how to reduce judging, look at their “biases” and pre-assumptions.
  • to change the process of how they think, how they relate to their thoughts and to their emotions; to see a thought as just a thought, a feeling just a feeling.
  • to do what works.
  • to look at medications as neither good nor bad– that taking a medication doesn’t “mean anything.”

With all the available books, CD’s, groups, classes, etc. that can teach interpersonal skills, assertiveness, cognitive skills, and various ways to calm one’s self, Mindfulness helps pull it all together. This is an important aspect of MFT that often is missed.

Just as a young carpenter may first learn how to use each tool—a hammer, saw, screwdriver– the more complicated step is to learn when to use each, in order to reach a goal. MFT helps the patient coordinate and integrate what they are learning from all around, stay conscious of their values, goals, and priorities, and make better decisions about what will work for the moment. It helps to recognize when they are getting sucked back into non-adaptive thinking and behaviors, and get back on track.

While MFT helps calm and settle the mind, it does much more. I reinforce to patients that they monitor themselves regularly and check in with themselves, asking “…what’s happening right now? …what am I thinking? …what am I feeling? …what are my priorities? …”.

We’re getting used to word processors with spelling and grammar checkers running in the background while we type; they let us know as we go when something’s off. We want Mindfulness running in the background, a “mind checker” that helps keep us calm, present, and objective, able to adapt and put to use what we’re learning as we go along.

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