Main description:

This book equips mental health professionals, students, interns, and post-graduate trainees to work effectively in a primary care setting - which today is the principal site for psychiatric care, behavioral health risk reduction, and psychological treatment of physical or functional complaints such as diabetes, hypertension, asthma, fibromyalgia, or irritable bowel syndrome. The primary care setting has a 'culture' that is very distinct from more traditional mental health settings, and so the first part of this book teaches professionals and students about the norms, communication styles, social rituals, and roles they need to be familiar with to be effective psychologists. Psychological therapies in primary care must be symptom-focused and brief. A broad-based epidemiological perspective is also necessary to address mood and anxiety disorders, medical nonadherence, and health risk behaviors such as alcohol abuse and smoking among a large number of patients.
Core chapters in the book therefore describe counseling techniques developed specifically for primary care such as the Four A's and BATHE, the Transtheoretical Model (TM), adaptations of Motivational Interviewing (MI) and Problem-Solving Therapy (PSA), as well as cross-cultural considerations and consultations as a mental health intervention. Equipped with these strategies and a deeper appreciation of primary care culture, readers will be well placed to adapt their clinical skills to this challenging and rewarding health care setting.

Contents:

Part I; 1. Characteristics of the Primary Care Setting; The "culture" of the clinic; Types of patient problems; Distinctive characteristics of primary care patients; Time: Pacing and scheduling; Documentation; Topography of the clinic: Where to see patients; Referral to specialty mental health providers; Basic issues in collaborative care; 2. Consultation with Physicians as a Mental Health Intervention; The nature of consultation in primary care; Clarifying professional roles and boundaries; Two common types of consultation: Patient-centered case consultation and consultee-centered case consultation; Types of consultation questions asked by primary care physicians; Clues to "unspoken agendas" in the consultation request; Types of answers that mental health professionals can provide; What to do when there is a request for consultation without an identifiable referral question; Guidelines for presenting the results of consultation: Written documentation and verbal feedback; 3. Applied Epidemiology: Screening as an Intervention; Population-Based Practice; Alcohol Abuse: Interview-based screening (e.g., CAGE); Paper and pencil screening (e.g., AUDIT); Presenting patients with screening results and recommendations; Smoking: Interview-based screening (e.g., Fagerstrom); Paper and pencil screening; Patient self-monitoring data; Presenting patients with screening results and recommendations; Mood Disorders: Demographics as screening aids; Paper and pencil screening; Brief interview Screen; Anxiety: Symptoms of medical conditions vs. anxiety disorders; Key questions for determining the presence of panic disorder and generalized anxiety; Co-morbidity of Selected Medical and Mental Health Conditions; Medical Adherence: The art of curious inquiry; Ethnographic questioning; Part II; 4. The Five A's and the FRAMES Approach; The Five "A's": Ask, Advise, Assess, Assist, Arrange; FRAMES: F = Feedback (Types of data and their effectiveness), R = Responsibility (How to communicate that the patient is ultimately responsible for her/his health), A = Assess (Determining the patient's readiness to change), M = Menu (Providing the patient with a choice of techniques for change), E = Empathy (Communicating understanding and support), S = Self-efficacy (Techniques for increasing a patient's confidence); 5. Stages of Change (Transtheoretical Model, TM); Background and basic philosophy; Evidence supporting brief TM interventions in primary care; Applications of TM; Determining the patient's current stage; Kaizen: The benefits of small steps; Specific counseling strategies for specific stages; Precontemplation; Contemplation; Preparation; Action; Maintenance; Lapses and relapses as part of the change process; Constructive counseling strategies for lapses and relapses; 6. Motivational Interviewing (MI); Background and basic philosophy; Evidence supporting brief MI in primary care; Moving from being the expert to the patient as expert; Implementing the four basic principles of MI in primary care: Empathic collaboration, Developing discrepancy, Rolling with resistance, Supporting self-efficacy and amplifying patient strengths; Using MI in follow-up visits; 7. The BATHE Technique; Introduction to BATHE: A five step acronym; Development in the primary care setting; Basic principles of BATHE: Efficiency; Keep the encounter moving forward; The patient is responsible for change; Issues and guidelines for each step of the BATHE encounter: Background: Keeping it focused, when less is more; Affect: Helping the patient address feelings; Troubles: What is the crux of the problem?; Handling: Adaptive and maladaptive coping; Empathy: Conveying support; Using BATHE in the follow-up visit; BATHE and Positive Psychology; 8. Structured Problem-Solving Therapy (PST); Basic principles; Background of PST; Representative research support; Support for PST in health care; The four steps: Guidelines and pitfalls; Problem definition: Strategies for specifying a focused problem; Brainstorming: "Priming the pump"; Evaluating and selecting options; Implementing a solution; Part III; 9. Cross-Cultural Issues; Cultural issues in adherence; Impact of culture on symptom presentation; Health beliefs; The Health Beliefs Interview; Examples of culturally based health beliefs; Responding to culturally-based health beliefs; 10. Conclusion: Matching Interventions to Patients; A prescriptive approach to selecting brief interventions; Problem type; Patient demographics; Patient interaction style; Case examples of patient-intervention matching; Concluding comments.