Psychology and Psychiatry

Psychology and Psychiatry: A Team Approach

By Art C. Arauzo, M.D., and Maryanne Watson, Ph.D.

Board Certified in Family Psychology

An article originally written for Treatment Today, October 1993 and reproduced for this web page

It has been our experience that a treatment team approach consisting of a psychiatrist and a licensed psychologist has tremendous advantages for both patients and clinicians.

The combination of the two similar yet distinct disciplines typically enhances our diagnostic abilities, significantly improves treatment planning, and improves treatment planning and approaches. It also increases therapeutic productivity, an issue of major significance in an evolving environment of managed nationalized health care delivery.

Historically, psychological diagnosis and treatment have been closely associated with the development and evolution of medicine and the “healing arts.” Disciples of different treatment approaches have been influenced by cultural considerations, social predispositions, academic proclivities, the availability of natural resources n, as well as the spiritual/religious environment. Over the past 400 years, at least in western civilization, technology and post-renaissance, post–enlightenment philosophy and science have all contributed to the formation and development of medical treatment approaches. The emphasis on reason and science led to an acceptance and predominance of the biomedical model in western medicine.

The emergence of the biomedical, scientific approach and treatment model has not, however, completely dissuaded the use of more holistic, interactive, and spiritual approaches. Many practitioners, including some physicians, continue to view medicine as both art and science and have continued to emphasize the role emotional, psychological, and spiritual issues play on the healing process.

First in a 1977 Science article and then in a 1980 article in the American Journal of Psychiatry, Dr. George Engel proposed the need for a new medical model of treatment, the Biopsychosocial (BPS) model. The BPS model is a holistic approach wherein a clinician takes into account both the biomedical considerations and the psychological/social circumstances of the presenting patient. By examining the psychological and social systems at work in the patient, the BPS model encourages, in theory, explorations, and dialogue beyond just the biological/cellular level. Despite the general acceptance of the BPS model most surveyed physicians admit that due to heavy case loads and time constraints, they often revert back to the more bio-medical-based model. As a result, while the BPS model is typically viewed as an attractive theory, it has been criticized for being a practical model for day-to-day medical treatment.

In our view, the combining of psychiatry and psychology overcomes this criticism. The two disciplines in combination come close to truly achieving the BPS model, in theory and application. While psychiatry evolved from the biomedical foundation (physical science) and psychology evolved from a mostly interactive base (social science), we feel the two disciplines are moving closer together. In combining and integrating the disciplines, the psychiatrist brings the biomedical model and training to the treatment approach, the psychologist contributes the psychological expertise to the team and together along with the patient, the social aspect is addressed. The real “winners” from this integration are the patients.

We believe that this benefit goes far beyond the synergy regularly achieved through co-therapy. We also believe that the combined disciplines working as a team provide the patient more numerous, comprehensive and productive diagnostic and treatment approaches. We have found our treatment options and plans are much more holistic and provide multiple levels of treatment possibilities including bio-chemical, medical, intrapsychic, and interact ional. All these increased options and considerations help produce a treatment environment laden with “possibility thinking,” creativity, and logic

Specifically, we have found that the psychologist typically, but not exclusively, provides the treatment a comprehensive range of options for therapeutic interventions including behavioral therapy, cognitive therapy, and family and group systems assessment and therapy. Our experience has been that the psychologist’s expertise in hypnosis along with superior psychological assessment and testing skills is of tremendous advantage in the diagnosis and treatment of trauma.

The psychiatrist, of course, takes the leading role in the treatment of medical problems and in medical management, a key component in the treatment of trauma patients with concurrent bio-chemical based diagnoses such as major depression, panic disorder, and anxiety disorder. The psychiatrist’s medical/organic/understanding of physical/chemical –based dysfunction is of tremendous value to the patient and treatment team. For example, our treatment regimen utilizes the psychiatric/medical expertise through anger therapy or in the treatment of self-mutilation tendencies.

We quickly understood that the best way to achieve a common goal was to utilize the strengths and professional expertise we individually brought to the team. The commitment to patient care, and our belief in team work, and a desire to learn as much as possible from the co-therapist, provided a solid theoretical foundation for combining the disciplines. The team building, synergy, and shared responsibility which resulted made it possible for the treatment whole to become greater than the sum of the parts. The combination of the interactive and the medical models has had tremendous benefits for use as therapists as well as for the hundreds of trauma patients we have treated. .

For additional information, contact Maryanne Watson, Ph.D., ABPP

Board Certified in Family Psychology

Art C. Arauzo, M.D.

Diplomate in Psychiatry

214-380-8600