Psychotherapies

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Clinical Psychopharmacology is the psychological practice of integrating psychological and biological treatments through patient psychoeducation and psychotherapy, and the collaborative integration of psychological medication management with the patient’s medication prescribers in the biopsychosocial treatment of psychiatric, psychological, and medical disorders.  Many psychological disorders are best treated with a combination of psychotherapy and specific medications.  A psychologist specializing in clinical psychopharmacology is an expert in recognizing when pharmacotherapy would be an appropriate component of the patient’s overall treatment plan.  Psychologists do not currently prescribe medications in the state of California, but a clinical psychopharmacologist can recommend and coordinate care with the appropriate prescribing practitioner, or coordinate care with the patient’s doctor of choice.

Clinical psychopharmacologists help patients who are good candidates for medications to better understand the benefits of considering pharmacotherapy in addition to psychotherapy.  When a patient is taking medications, a clinical psychopharmacologist is an expert in psychoeducation and can help a patient to understand the medications that have been prescribed, why the patient has been prescribed these medications, what common side effects are and how the drugs are metabolized, how the various drugs that the patient is taking may interact with one another, and encourage medication compliance.  A psychologist trained in clinical psychopharmacology is in frequent contact with the prescribing doctor to optimally coordinate psychological and medical care.

Psychologists who specialize in clinical psychopharmacology are thoroughly trained in the scientific foundations of psychopharmacology including biochemistry, neurochemistry, neurophysiology, neuroanatomy, neuropathology, clinical medicine, pathophysiology, and physical assessment.  Clinical psychopharmacologists are also trained in the applications of psychopharmacology including the use of antidepressants, antianxiety medications, antipsychotic medications, mood stabilizers, and drug/drug interactions.  Specialized training also includes the use of medications with children, adolescents, geriatric patients, pregnancy and women’s issues, chronic pain, chronic medical conditions, chemical dependency, and ethnopsychopharmacology.
 

Following some type of head injury, stroke, oxygen deprivation, dementia, psychiatric illness, or other scenario in which the brain is damaged, individuals who experience such events often experience a decline in one or more areas of mental functioning, including memory, ability to pay attention and concentrate, organizing information, and mental speed. Similar to the manner in which an individual may undergo physical therapy following an injury to a muscle and engage in various exercises and movements to strengthen the injured area and restore it to its previous level of functioning, cognitive retraining (also known as cognitive rehabilitation) utilizes various techniques and mental exercises to enable people to regain or retain specific mental capacities following an injury or other decline in mental functioning.

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When trauma occurs (e.g., physical, emotional and/or sexual) the child’s own internal experience and emotions are not validated. In the optimal family, public validation of private experience is given frequently, which leads to emotional regulation and the development of a healthy sense of self. In contrast, the invalidating environment contributes to emotional dysregulation by failing to teach the child to label and modulate arousal, to tolerate distress, or to trust his/her own emotional responses as valid interpretation of events.

 

Dialectical Behavioral Therapy (DBT) was created by Dr. Marsha Linehan in order to learn and refine skills in changing behavioral, emotional, and thinking patterns associated with problems in living, that is, those causing misery and distress.  DBT addresses the problems that one experiences including confusion of self, roller-coaster emotions, impulsiveness / self-harming behaviors, and interpersonal conflicts. The main framework of treatment is divided into four modules where the individual masters various tasks. First, Mindfulness teaches the individual to stay in the present moment and to learn how to observe their thoughts and emotions without acting on them. Second, Emotional Regulation Skills focuses on learning how to gain more control over one’s emotions without immediately reacting to internal and external triggers. Third, Distress Tolerance Tolerance provides an individual with a variety of tools with which they can utilize to tolerate emotional distress that happens in everyone’s daily lives. It is key to understand how an inability to tolerate distress can lead to impulsive behavior (e.g., self-harming behaviors, sexual exploits), which the individual believes will relieve the distress but only serves to create more intolerable distress. And, the last module is developing Interpersonal Effectiveness Skills. This module focuses on learning how to deal with conflict, to learn how to get one’s needs met appropriately, and to say no to unwanted requests and demands from others. It focuses specifically on doing this in a manner that maintains self-respect. Overall, DBT assists the individual in becoming aware of their thoughts and feelings, developing distress tolerance which reduces impulsivity and thus improves their ability to connect with others.

 

EMDR is an interesting and complex approach to the treatment of posttraumatic stress disorder (PTSD), anxiety, and for the use of performance enhancement. It is essentially an accelerated form of information processing that is utilized within a comprehensive treatment plan to promote your recovery and overall well-being. To date, research supports the idea that EMDR works well in the treatment of trauma. We know that when something traumatic or disturbing happens to you, your mind may continue to hold onto it in a way that includes the original picture, sounds, feelings, sensations and thoughts. It seems like the trauma is locked inside and it can be triggered by a variety of sights, sounds and people that you encounter throughout the day. Essentially, you are re-experiencing the emotions and physical sensations of the old experience. EMDR appears to work by processing the old images, sounds, feelings, sensations, and thoughts. The result of effectively processing this material is the alleviation of symptoms and the development of an enhanced sense of well-being.

EMDR is an information processing therapy and uses an eight phase approach to address the experiential triggers of a wide range of pathologies, including trauma and anxiety. It attends to the past experiences that have set the groundwork for the current symptoms, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.

During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations.
 

Family-Focused Therapy (FFT) is a type of family psychotherapy for Bipolar Disorder in which patients and their families meet with a psychologist who is trained in this form of treatment. Scientific research has demonstrated that it is more effective to treat bipolar  disorder with FFT and medications than to treat patients with medications only.  In some cases of mild bipolar spectrum disorder, patients can be treated with FFT alone, without medications.

FFT includes extensive psychoeducation that covers symptoms of bipolar disorder, known causes, typical course of illness over the lifespan, treatment, and active self-care of Bipolar Disorder.  Patients and their families are encouraged to come together to develop a common framework for understanding of the triggers of relapse, risk factors for future episodes, probable need for maintenance psychopharmacology and psychotherapy. A relapse prevention plan that involves the whole family is created that includes a rescue strategy in which early signs and symptoms of illness are recognized and responded to rapidly by the family system. 

FFT also includes communication enhancement exercises in which levels of negative emotion are reduced and more adaptive communication skills are identified and rehearsed. Family problem solving skills regarding the illness and the home environment are also discussed and rehearsed.

For more information about FFT, please consult the following resource:

Miklowitz, D.J. (2002). The bipolar survival guide. New York: Guilford Press.

Miklowitz, D.J. (2008). The bipolar teen: What you can do to help your child and your family. New York: Guilford Press.

 

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Following a significant loss (such as the loss of a child or loved one), many people experience intense feelings of grief that severely impact their lives and ability to successfully and effectively adjust to their new circumstances. Grief can have a number of adverse consequences and can cause feelings of sadness, anxiety, anger, isolation, and numbness. Individuals may also experience difficulties concentrating and staying organized, trouble sleeping, loss of appetite, and vivid dreams or daydreams of the individual they have lost. Grief counseling focuses on these problematic areas with the intent of assisting the individual and their family to come to accept their loss and positively adjust and move forward with their lives.

The surge of obesity and bariatric surgeries has increased the utilization of psychologists to assist in weight-loss treatment, concerns about body image, psychosocial assessment for surgery candidates, pre-operation therapy, and post-operation treatment surrounding complications and lifestyle adjustment.  Obesity is more prevalent among Americans with serious mental illness than those without mental illness.  Psychologists implement cognitive-behavioral therapy techniques to improve mental health issues, body image concerns, self-esteem, restructure beliefs about dietary habits, and improve intimate relationships.  Additionally, psychologists trained in psychopharmacology, are able to provide psychoeducation and consultation to physicians about medications contributing to weight gain.  Bariatric surgery candidates are evaluated by psychologists to make a recommendation about a patient’s psychosocial functioning.  Psychologists provide treatment to prepare pre-operative patients for lifestyle changes, motivation, and coping skills.  Complications may occur post-surgery and psychologists provide assistance with stressors, motivation for medication and dietary compliance, reemergence of psychological disorder, and weight regain.    

Diabetes is a group of metabolic diseases in which defects in insulin secretion or action result in high glucose (blood sugar) levels.  Insulin is a hormone that converts blood sugar into energy.  There are approximately 24 million adults and children who have diabetes.  Millions of these people are unaware they have diabetes.  Correct diagnosis is important as many diabetic symptoms mirror symptoms of major depression and anxiety.  Additionally, many psychiatric medications are related to the development or contribute to diabetes complications.  There are four main categories of diabetes.  Diabetes Mellitus, the most common form, appears as either Type-I Diabetes or Type-II Diabetes.  Other common forms of diabetes are Gestational Diabetes and Pre-Diabetes.  

Mental health and substance abuse are significantly related to poor blood glucose monitoring, decrease in medication compliance, and an increase risk for diabetes complications.  Approximately 65% of diabetes deaths are due to heart disease and stroke.  Neuropathy (nerve damage), obesity, retinopathy (eye damage), nephropathy (kidney disease), glaucoma, cataracts, and gum disease are all common complications of poorly maintained diabetes.  These complications tend to be long-term, but for children or young adults, they often have trouble understanding how important self-care is.  Some individuals with diabetes spectrum disorders need professional mental health assistance when dealing erectile dysfunction and life-threatening issues.  Dealing with diabetes complications can be overwhelming and may lead to further mental health issues and treatment non-compliance.  

Psychologists, who specialize in the psychological implications of diabetes, create a complete care-plan package that includes consultation with: endocrinologists, internists, dieticians, pharmacists, psychiatrists, and family members.  Psychologists help individuals in identifying risk-factors that contribute to diabetes, provide a collaborative lifestyle change plan pre-or-post diagnosis, and provide psychopharmalogical education about medications that are associated with a higher-risk for development of diabetes.  Cognitive-behavioral therapy techniques, such as: improving patient motivation, stress management, self-monitoring, identifying triggers that lead to non-compliance, and identification of false perceptions, are imperative to successful outcomes.  By utilizing the stages of change model, psychologists and individuals can collaboratively set attainable goals.   
 

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Interpersonal and Social Rhythm Therapy (IPSRT) is a specialized type of brief individual psychotherapy for bipolar disorder.  Scientific research has demonstrated that it is more effective to treat bipolar disorder with IPSRT and medications than with medications alone.  In some cases of mild bipolar spectrum disorder, patients can be treated with IPSRT alone, without medications.

IPSRT is typically 16 to 20 sessions conducted over a six month time frame.  IPSRT focuses on stabilizing social rhythms and helping the patient to better manage current interpersonal problems so as to help prevent a relapse of bipolar symptoms.  Treatment techniques include completing an Illness History Timeline, psychoeducation, and Interpersonal Inventory, and focus on an Interpersonal Problem Area.  Patients are helped to stabile their 24 hour circadian rhythms, sleep/wake cycles, and daily schedules through social rhythm therapy.  Psychoeducation symptoms, known causes, typical course of illness over the lifespan, treatment, and active self-care of bipolar disorder including sleep hygiene and factors affecting regulation of circadian rhythms.
 

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