The Foundations of My Approach to Treating Major Mental Illness:
- Pace of treatment must be determined by the comfort level of the patient; the therapist must be comfortable with the possibility that progress may be slow and in small increments
- Quality of life worth celebrating is achievable and must a consistent and primary treatment outcome
- If the patient does not experience improved quality of life over time, the treatment is failing
- Psychotherapy for persistent mental issues should focus on achievement of one’s personal best rather than trying to fulfill what may be impossible social demands
- A therapeutic alliance, which is an intimate relationship of mutual trust and respect wherein therapist and patient come together in the service of one: the patient, is an indispensable element of successful treatment
- The best way to reduce symptoms, heighten function and improve quality of life includes a combination of insight oriented psychotherapy, behavior modification and medication management
- Intensive collaboration among patient, psychotherapist and psychiatrist is a necessary element of effective treatment, with the addition of trusted others if and only if the patient desires it
- Maximization of patients’ rights to be fully involved in treatment choices and goals
- No “one size fits all treatment” is possible; treatment must be tailored to the preferences and needs of individuals
- Psychotropic medication must be carefully monitored and adjusted up or down as symptoms change, side effects arise and environmental stressors wax and wane
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Psychotherapy works best when it is strengths-based, and follows a recovery model
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Acknowledgement and application of special treatment needs for Dual Diagnosis (mental illness with addiction): because the whole is more than the sum of the parts
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Psychotherapy must acknowledge and address the social stigmatization of those who live with mental illness
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Positive, affirming therapy must be extended to those whose lifestyles are “extra-traditional”
- A permanent therapeutic alliance reduces the time and intensity of distress if inevitable stressors of reality result in symptomatic relapse despite treatment compliance; the alliance is of equal importance with medication
- Psychological support and psychoeducation for family and extended family is essential, not only to meet their own needs (they hurt too), but also to ease the guilt and shame due to patients’ awareness of their loved one’s distress
