Open Lines and Open Minds for Close Collaboration Between Psychiatry and Therapy

Written by

Kevin Conley, PMHNP

During my educational track, I worked with two psychiatric providers that shared opposing views on therapists and collaboration. One of my colleagues disliked therapy, therapists, and collaborating with therapists. I watched in shock as this person belittled therapists and rejected valuable information from them. I also watched this provider repeatedly lose clients who weren’t getting the care or outcomes they needed.

Soon after, I was given the opportunity to work with a colleague who valued therapists and the insights they would share and who welcomed close collaboration. I watched as her clients came back, month after month, gradually getting better while receiving quality mental health care from a team that was working together in close collaboration.

Kevin Conley, Psychiatric Mental Health Nurse Practitioner

Mental health disorders exist on a spectrum and can range from mild to severe and varying levels in between. Some of these conditions are better treated with therapy, while
others will require medication management. However, what we see the most is the need for a multimodal approach that incorporates some form of therapy and medication management to help our clients receive the most benefit for their mental health.

With the pandemic and social isolation of 2020, many people started experiencing mental health problems for the first time, while others experienced worsening of preexisting conditions. That crisis highlighted an existing deficiency and a need for increased access to mental health care quickly became evident. As clinicians, we all saw that coming from a mile away, and we were eager to help those in need.

This multimodal approach is backed by science and valid data that supports a collaborative model of mental healthcare. Collaborative models can help guide care and improve outcomes through therapists, psychiatrists, and psychiatric nurse practitioners working hand in hand to identify concerns and share knowledge and insight.

Combining each science’s strengths

The practice of psychiatry is rooted in science with a heavy emphasis on prescribing. As psychiatric providers, we spend countless numbers of hours continuously increasing our knowledge about the neurology and chemistry of mental health.

With each new client, I listen to them tell me about their signs and symptoms while I’m thinking about neurotransmitters, dopaminergic pathways, medical problems, allergies, drug interactions, and what medication is best suited for their condition and to improve the quality of their life. This kind of training and expertise makes a difference when prescribing psychiatric medication. Sometimes we’ll have clients who have taken steps to get better by talking to other doctors or general practitioners but aren’t seeing the results they need—or worse, end up with negative results—because that’s not their discipline.

Typically I spend an hour with a client one time before prescribing a medication, and my follow-up appointments are usually once a month to every three months. These follow-ups are primarily centered around measuring symptom changes, medication response, and making necessary adjustments.

Therapists, on the other hand, get to spend more time focusing on the individual client and their mental health. Therapists explore ways to treat symptoms through the application of therapeutic modalities and techniques that support recovery, growth, and improved functioning while simultaneously gaining more profound levels of knowledge and insight into their clients.

Therapists can do this in more meaningful ways than I can in my one-hour intakes and subsequent 15 or 30-minute follow-ups. Therapists teach skills and help modify thoughts, perceptions, and behaviors, and those foundational aspects of therapy can last a lifetime for clients—which is much longer than the effects of any medication. I get to know my clients and I care about every one of them, but I also recognize that therapists typically KNOW their clients to a deeper degree than I do, and therapists have valuable insight to share.

When the providers of these separate but equally essential modalities can come together to share insight and knowledge, clients benefit by receiving care from a therapist who can emphasize the benefits of adhering to medication regimens. That same client can also benefit from a psychiatry provider who reinforces the benefits and value of therapy with the client while also sharing valuable diagnostic data with their therapist.

Writing an effective psychiatry referral

A good referral can be part of the collaborative process. I can use a therapist’s deep knowledge about their client to prepare for our session and to begin thinking about diagnosis and prescriptions.

Here are some recommendations for information to include that make referrals more useful for me and clients:

  • Symptoms and other information about what the client’s experiencing
  • Any diagnoses, previous or current, about the client
  • Treatment history, including what’s been effective and if the client has been hospitalized before to help me gauge complexity
  • Medication historyIt can be time intensive but when therapists share that information, it saves time for sessions and treatment so we can rule out what didn’t work.

Uplift was formed to increase access to mental health care for those in need of therapy and psychiatric services. We’ve already made it easy for therapists to refer clients to psychiatry—where clients can also benefit from in-network rates. At Uplift we’re working on more tools to facilitate communication and information sharing between psychiatry and therapy.

As clinicians, our goals are the same: to support clients in making meaningful and measurable change in their lives. The more we collaborate, the better we do that.