Mind-Body Medicine in Inpatient Psychiatry. David Låg Tomasi

cognitive regulation, develop life and coping skills, better understand stressors and triggers and monitor vs/control their reactions. Problem-solving strategies are also at the center of group sessions such as the “Solve that Problem” and the “Wellness and Recovery Action Plan” developed by Mary Ellen Copeland (1997). Interpersonal Therapy techniques are also used to target communication skills and identify problems in relationships, while Psychodynamic therapy and counseling techniques are generally discussed in the form of basic theories and techniques in group sessions, and applied more in detail and with added focus during individual psychotherapy sessions, especially in the context of Posttraumatic stress disorder or other trauma-related psychological difficulties. These represents cornerstones of the psychotherapy-based interventions, an aspect discussed multiple times by therapist. In other words, since the Inpatient Psychiatry Units are “locked” units, the patient is brought to a deeper understanding of both challenges and opportunities for her/his healing process. If the patient might at times feel “closed in” “unable to relate to the external world,” “separated from family, friends, and opportunities,” she/he will also be “separated” from triggers, traumas, stressors, and even—another fundamental point in mind-body strategies—from addiction-related problems, such as specific temptations or external stimuli. Following the Therapist’s Perspective guidelines of the UVM Medical Center, these are the most important points followed in both clinical interventions and research study (Bancroft et al., 2014):

      1 Evidence of increase in awareness or insights on the part of the patient(s), coupled with increased hope. Measurement: Patient’s self-report in session reflects understanding of the concepts or principles under discussion. Hope may not always be a component.

      2 Patients fully participate in discussion and in whatever the directive of the group is. Measurement: Patients are attentive and engage in meaningful dialogue, complete associated worksheets or questionnaires.

      3 Patients being respectful and supportive of each other, offering their own insights from their experiences as a help to their peers. Measurement: Patients operate within the confines of group norms as given by the therapist, they respect the personal space of their peers, remain silent while others are speaking, they offer on-topic, reality-based supportive comments.

      4 There are few if any disruptions to group (i.e. staff needing to see a patient, or for a phone call/favors, patients with psychosis and disorganization). Measurement: Disruptions must not derail the continuity of the collective group process.

      5 Sense of community on the milieu. Measurement: Patient alliances and unit camaraderie are intrinsic to satisfying group experiences.

      Beside the organizational—teamwork perspectives discussed in the list above, there are many other essential task in the daily clinical work of Psychotherapists/Group Therapists. It is very important to note that, especially in the context of “Mind-Body Medicine strategies in Inpatient Psychiatry” the clinical intervention of a therapist covers the entire spectrum of activities and interactions on the unit. Thus, the clinical work starts with the solid preparation of evidence-based strategies for therapeutic sessions, continues with the meetings with the patients, and is monitored, controlled, and verified through electronic health records and clinical notes during the patient admission. Of course, to guarantee safety and privacy to each patient, the same level of attention and precision is required by every therapist also upon patient discharge. To explain all these aspects more in detail, we can refer to the list of Inpatient Psychiatry Group Therapists/Psychotherapists general/main tasks presented below:

      1. Charts

      Documentation

      i. Prism EHR

      ii. Therapy Group SOAP notes

      iii. Clinical Assessments/database

      iv. Signing of Multidisciplinary Treatment team (MT) notes daily

      v. Signing of Safety Plan notes daily

      vi. Reading Charts

      2. Groups

      Group rules

      Observing groups

      Co-leading groups

      Taking the lead in group

      MD/RN/SW Students observing

      Yoga/meditation supplies

      Relaxation CDs (order is needed for private patient use of boom box and CD from MD)

      Journals

      Karaoke machine

      i. Location of

      Games

      i. Location of

      Pet Therapy

      Art Group

      i. Safety issues

      ii. Giving out of supplies (hoarding & safety)

      Garden group

      i. Pt eligibility to go (sometimes orders are needed)

      ii. Calling Security

      iii. Security’s role in general

      iv. Calling Facilities re fans

      Focus Group

      i. Scheduling of

      ii. Questionnaire

      iii. Orientation → Favors

      iv. Typing up of responses from questionnaire

      3. Morning daily clinical rounds

      Scheduling of Rounds & Signatures of ITP & MT notes

      Observing Rounds

      Presentation of summary of patient group participation/other input

      Rounds book

      Writing of update notes on each patient during Rounds.

      4. Therapy Scheduling

      Weekly schedule of groups

      Monthly individual schedule

      Scheduling of vacation/holidays

      5. Basic Readings & Handouts

      Cognitive Behavioral Therapy

      Dialectic Behavioral Therapy

      Grief Group handouts

      Relaxation/Grounding techniques

      6. Administrative

      Computer/Prism passwords

      Phone Codes

      Copier Codes/Door code

      GT communication log

      Ordering of supplies

      i. Budget

      ii. Schedule of who orders

      iii. Catalogues/Online (more accurate prices)

      iv. Creating list for orders

      v. Special Orders

      7. Group Therapy Supplies Storage Spaces

      Closet on 3

      Overflow in Supply room on 3

      Art Room

      Closet/cabinets on 6

      8. Keys

      Patrick office/Shepardson 5 office

      Art cabinets

      Closets

      Team station/group rooms/bedrooms/bathrooms

      9. Daily Tasks

      Check GT Log

      Check White board and add group schedule

      Check for new patients/sign up for DBs

      Update