What substantiates the “comprehension” in the “comprehensive approach”? Therapeutic efforts are now honoring hormonal factors, proteins, and chemicals in the bloodstream … of looking at metabolism and inflammation. What this means is the level of the whole body and how those components filter into the brain and change both the structure and the function of that organ, therefore, the body we work with as professionals. This is thinking about the context in which the brain is functioning, directly and indirectly going in and changing what is happening there in relation to the rest of the body and person. Yes, that includes thoughts as well as what are increasingly other essential components of proven treatments. This is where the field is and will increasingly be headed. It’s worthwhile for … essential that clinicians start acting on, if not contributing to this research, rather than thinking about. Despite the initial impression, these are things that people can make choices regarding. These are things that complement psychotherapy; compliments, not threats to our profession. Self-empowerment will increasingly become “I’m really impacting my brain chemicals as well as my behavior through the choices that I make.”

What is different now is the value of no longer differentiating functions into primarily biologically driven states versus those that driven by psychological processes. We get into trouble when we treat the latter and not the former, certainly not together. With our application of research, we are establishing a field in which we are less focused on differentiating between them with attention of one at the expense of the other. Fascinating research has included the work on microbiomes and demonstration of the effects of gut bacteria on mood, thereby influencing our selection of treatment for anxiety and depression. Who would ever have imagined that mental states would be a relationship with what we eat and the bacteria that respond to same? Biological factors can alter how a brain functions in a way that produces hope or despair, creating patterns of thought and emotional tendencies that were earlier viewed as abstract or conceptual, not so concrete and physical.

I am talking about the power of underlying physiological states, biological states, in shaping the mind. The importance is to now identify and address ground related underlying bodily states. This change means that there is one mind-body system with many points of access, “psychological” and “medical” not “or.”

Assessments will now include the question of “what is the physiological aspect that needs to be addressed? What is the cognitive aspects?” What I am talking about is a field in which more attention is placed on individual history. This change is one that impacts our functioning as a profession unlike ever before in such a short period of time.

What is the change I plan to guide us to undergo? By addressing bodily states as problems that are attempts at solutions, framing adaptive coping responses in a way that empowers our patients. What hasn’t changed is the importance of telling the truth: what a difficult problem it is, how many underlying factors there are, and that no one is necessarily to blame. Even in combination with what are now necessary physical exams, medical tests, we may not know all the things that fed into it. What has changed in the field … what will change here in this facility is excitement and empowerment that there are more things … more important things that we can do in solutions.

We’re moving into a psychoneuroendocrine immunological package of attention on the big picture regarding how factors affect states. Our immune system is one in which systematic inflammation effects emotions. No matter what the initial trigger, our immune systems can be changed by experiencing social defeat or grief, real life contexts that need to be dealt with. We are talking about a significant change in a client’s physiology that will continue to sustain a reciprocal, possibly increasingly detrimental relationship with the psychology unless they are both addressed. I support my statements with a reminder that is not new research that in the first six months functions drops in the immune systems of people who are grieving.

As we move from empathy to compassion in our facilitation of sessions, the pre-motor planning circuitry in the brain tends to activate. We still have therapeutic techniques, ones that have shifted, as I addressed earlier. That integration continues to see us ask the questions “when did this begin” as well as assessing whether there was a precipitant. Attention to the existence of drug or alcohol use or abuse has not changed. What has changed is that answers now require attention to the need to support the nervous system so that brains can then perform, or more effectively perform, processing.

I am not proposing that we play or that we have to play the role of physician. We are well aware of necessary license boundaries. We are reminded on a yearly basis in the ethics course we are required to complete to maintain our license that professional boundaries are important. What I am saying is that we have to educate ourselves regarding the basics necessary to carry on a therapeutic conversation with those physicians as well as to be able to include the physical health elements in our thinking and therapeutic planning. The purpose of both is to make sure, from our checklist, that as much is being done to strengthen the full body health of our clients as much as possible. That means working closely with medical staff is now a professional obligation: “integrated behavioral health.”


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