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Pearls


Improving collaborative treatment: 6 simple steps

Vol. 4, No. 10 / October 2005

Collaborative (or split) treatment—when therapists provide primarily psychotherapy while psychiatrists manage medication1—carries benefits and risks (Table).2 Six simple steps can improve treatment quality for both patients and the treatment teams.

Obtain the therapist’s diagnostic evaluation before the patient’s first visit with you to learn why he or she sought help from a mental health professional.

Reduce liability risk by asking the collaborative therapist to share significant developments in the patient’s life such as suicide attempts, traumatic events, medication side effects, etc. Document that you had this discussion.

Read the therapist’s recent progress notes every time you see the patient to greatly reduce chances of “splitting,” a type of interference in which a patient sides with one person or faction that causes infighting within the team. If the collaborative therapist practices at a facility other than your own, ask the therapist to send you a summary of his or her notes periodically.

Encourage the therapist to discuss medication early. Even if the therapist does not expect medication to become necessary, suggest a discussion about the possibility of a medication trial with the patient early in treatment. This can avoid confusion about the psychiatrist’s and therapist’s roles later in therapy.

Discuss medications’ limitations to minimize therapists’ and patients’ impulse to change medication whenever the patient endures an emotional challenge or mild side effect.

Maximize communication with e-mail and phone calls. Schedule time for communicating with collaborative therapists. Above all, maintain mutual respect for different disciplines.

Table

Benefits and risks of collaborative treatment

Benefits

More available clinical information

Possible cost effectiveness

Emotional support among clinicians and more support for patients

Risks

Risk of “splitting”* (when a patient sides with one person or faction, causing infighting within the team)

Shared legal and clinical responsibility

Miscommunication and the risk of making uninformed clinical decisions

*More common when treating patients with personality disorders.3

Source: Reference 2

References

1. Goin MK. Split treatment: The psychotherapy role of the prescribing psychiatrist. Psychiatr Serv 2001;52(5):605-9.

2. Balon R. Positive and negative aspects of split treatment. Psychiatr Ann 2001;31(10):598-603.

3. Silk KR. Split (collaborative) treatment for patients with personality disorders. Psychiatr Ann 2001;31(10):615-22.

Dr. Khawaja is clinical assistant professor, department of psychiatry, University of North Dakota School of Medicine, and medical director, Lakeland Mental Health Center, Fergus Falls, MN.

Dr. Ebrahim is an internist/endocrinologist in Park Rapids, MN who collaborates with psychotherapists in the community.

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