And here's another apparent advantage of bringing together the medical and psychological disciplines: It becomes easier to provide care for people with disorders like chronic pain and insomnia that don't clearly fit into DSM categories; for people whose disorders are medical but clearly have psychological or relational components, such as irritable bowel syndrome and high blood pressure; and for people who fit into multiple categories, such as alcoholics with renal system problems.
The advantages of this new, collaborative system are evident in the case of a woman I'll call Kathy, a 23-year-old retail worker. Kathy was a client of family therapist Tom Mahan at the innovative Marillac Clinic in Grand Junction, Colorado--a model of how the integrated health care system of tomorrow can function at its best. She went to the clinic complaining of nausea, fatigue, feelings of helplessness and a constant burning in her chest. Kathy had seen six doctors in five years, and each one had told her she had no medical problem. Most recommended that she see a therapist, but she had rejected the idea that she had a "mental problem" and never followed this advice.
Then she visited the Marillac Clinic. She was seen first by a doctor, who conducted a sophisticated assessment of her biomedical, psychological, social and even spiritual life. At the end of the interview, the doctor told her that while she might have gastroesophageal reflux disease (GERD), psychosocial factors, such as high stress, relationship difficulties and perhaps depression, exacerbated her illness. He asked if Kathy would be willing to meet with "a behavioral care specialist" for some additional input and Kathy gave a tentative "maybe." So Mahan joined the interview and, in the course of an amiable chat, was able to demystify psychotherapy and explain the relevance of Kathy's emotional state to her physical complaints. By the end of the session, Kathy had agreed to meet with him to work on managing her "stress."
They met for three sessions. Kathy liked Mahan and felt she was finally making progress. While she responded positively to the treatment for GERD, which included medication and dietary changes, as well as to an antidepressant prescribed by the intake physician, she also began examining the psychosocial stressors in her life. Kathy talked about her dead-end job as a retail clerk, her frequent arguments with her boyfriend and her wish to move out of her parents' home. With Mahan's coaching and support, Kathy became more assertive in managing her own health: She learned more about GERD, formulated questions for her physicians and transformed from docile observer to active, informed consumer.