Areas of Specialization in Behavioral Healthcare
CNS was originally founded on the innovative concept of integrated and interdisciplinary care, where patients benefit from the input and expertise of multiple clinicians from different specialties in or related to mental health.
While still early in development, it was immediately apparent that the CNS integrated approach to care was immensely helpful to patients. However, like most other youths, CNS was not without its developmental challenges.
In developing a practice with such a comprehensive array of clinicians, the biggest challenge was that of clearly identifying the distinct areas of expertise of each professional background. While facing this challenge, we quickly learned the truth that even within our own field, many mental health clinicians are genuinely not fully familiar with what our own colleagues in neighboring fields are doing! This may be due to the fact that while still in training, there is little to no interface between clinicians from the different facets of mental healthcare. This may be due to the fact that there are many roads to behavioral healthcare: physicians from the world of medicine, psychologists originally stemming from academia, and other clinicians, such as counselors, coming from schools of professional – or clinically-oriented backgrounds. Regardless, we believed that the lack of familiarity within and even between clinicians in our own field was our own fault.
While working to develop our integrated model of behavioral healthcare, we realized that if we, as mental health clinicians ourselves, could not clearly delineate ourselves from each other, then how could we expect the community to do so? The answer was clear: we couldn’t.
So we decided to essentially start from scratch. Our teams of psychiatrists, psychologists, nurses, therapists, interventionists, and others – we all started from the beginning. We talked. A lot. We gave each other presentations about our fields, their origins, and our training. We shared our philosophies and our impressions of different clinical scenarios and of our patients. We learned from each other.
The following is a framework of the main areas of expertise that make our different specializations distinct and unique. Hopefully this helps. But keep in mind that these are significant generalizations; expertise and experience varies widely between individual clinicians. In fact, in mental health, the most important factor behind a clinician is the clinician him or herself – their experience, approach, and knowledge base. Not the degree or school from which they hail.
Psychiatrist (M.D.): a psychiatrist is a physician, or medical doctor (M.D.), specializing in the field of mental health. The training of a psychiatrist is generally the same as for any other physician, such as internists, pediatricians, or surgeons. Education includes: four (4) years of college, four (4) or more years of medical school, and four (4) or more years of residency training. As physicians, psychiatrists are generally trained to hone in on the aspects of illness or disease process in mental health. As with other physicians, psychiatrists have learned to treat the most severe cases of mental illness, and are therefore usually very equipped to treat more mild or common cases. Psychiatrists focus on physical and psychological signs and symptoms of mental illness, abnormal or maladaptive thoughts or psychological traits. Areas of specialization of a psychiatrist include: 1. Accurate and finely-honed skills in diagnosing specific mental illnesses, 2. Medicinal (prescription) and other interventions to treat mental illness, 3. Treatment of mental illness that is resultant from or related to other physical conditions (e.g. medical conditions, biological, neurologic, sleep, pain, etc), 4. Function as an interface between the fields of mental health and the medical world (e.g. ordering radiologic or other studies, requesting consultations with other medical specialists, admitting patients into higher levels of care such as inpatient hospitalizations and medical centers), and finally, 4. because of their significant experience working in medical centers, often serve as the head of the Treatment Team of Clinicians.
Psychologist (Ph.D. or Psy.D.):
Clinical Psychologists and Neuropsychologists
Clinical Psychologists study the physical, cognitive, emotional, and social aspects of behavior. Psychologists are doctoral-trained professionals who conduct research, perform psychological testing, and evaluate, diagnose and treat a full range of emotional and psychological challenges. The primary activities of clinical psychologists are psychological testing and evaluation, diagnosis of psychological difficulties, individual psychotherapy, and research to discover ways to improve well-being, teaching, and consultation.
Neuropsychologists specialize in the study of brain behavior relationships. Specifically, they primarily focus on the assessment and treatment of one’s cognitive impairments as they pertain to any underlying psychiatric, neurologic, medical, or developmental conditions. Furthermore, neuropsychologists specialize in central nervous system functions as it pertains to cognitive functioning and ability to carry out instrumental activities of daily living (e.g., work, school, driving, etc.) They have extensive training in brain and spinal cord function and how it affects cognitive activities such as awareness, reasoning, judgment, learning, and memory.
Marriage and Family Therapists, Behavioral Therapists, Educational Therapists
Marriage and Family Therapists (MFTs) are relationship specialists who treat individuals involved in interpersonal relationships. They are trained to assess, diagnose and treat individuals, couples, families and groups to achieve more adequate, satisfying and productive marriage, family and social adjustment. Marriage and family therapists help people learn to solve family problems by managing close relationships in productive, cooperative, and satisfying ways. These clinicians are psychotherapists licensed by the State of California. Requirements for licensure include a related doctoral or two-year master’s degree, passage of a comprehensive written and oral examination and at least 3,000 hours of supervised experience.
Behavioral Therapy is built upon the principle that if reactions (behavior) to stimuli are learned, they can be unlearned. This therapy differs from other therapy modalities, as its main focus is on the present and the person’s current level of functioning. Some of the main components of behavioral therapy include: relaxation reduction, stress reduction, systematic desensitization, and reinforcement. Many elite athletes and performers often receive guidance from behavioral therapists to assist with goal setting, imagery and visualization techniques, as well as relaxation exercises in order to think clearly during games and performances. Furthermore, “behavioral coaching” has become a significant aspect of treatment for ADHD to facilitate organizational, time management, and self-management activities.
In general, a Social Worker helps people to identify and find solutions to problems they face in their daily living. Social workers may assist individuals, couples, families, groups, communities, and organizations. Specifically, they help to resolve social and personal problems related to illness, disability, unemployment, substance abuse, spousal and child abuse, and other emotional and behavioral problems. In addition, these clinicians may play larger roles in the mental health community, directing and administering programs. In addition to earning their MSW, others train to become a Licensed Clinical Social Worker (LCSW). An LCSW is licensed to provide psychotherapy and counseling.
Educational Therapists offer children and adults with learning disabilities and other learning challenges a wide range of intensive, individualized interventions designed to remediate learning problems. Specifically, educational therapy is an intervention that investigates, defines and addresses an individual’s pattern of learning strengths and deficiencies. One important goal is to increase the individuals’ awareness of their learning strengths and weakness in order to maximize positive learning skills and minimize any weaknesses that are presented. Educational therapy differs from “tutoring” in that it addresses underlying learning skills such as visual and auditory processing, attention and focus, and memory skills. Academic skills such as reading and writing are remediated after weak processing skills are identified and addressed.
The CNS Case Coordination Program provides community-based services to individuals who are struggling to manage or make progress in pursuit of the quality of life they desire. The philosophy of Case Coordination revolves around the idea that patients can lead meaningful and vital lives if they are: medically and psychologically stable, participate in healthy activities, maintain structure and balance, and are productive members of their community.
The Case Coordinator serves as the care partner to the physician and the treatment team. This individual makes weekly rounds with members of the medical staff and transitions from reactive chart review to proactive treatment planning, resource management, and individual coaching and counseling. The CNS Case Coordinator serves as the single consistent resource to the family and physician and enhances communication among all treatment team members. In addition, case coordinators monitor any barriers to the patient’s efficient navigation through care, offering feedback, advocacy, and problem solving support.
Furthermore, the Case Coordinator will schedule and facilitate treatment team meetings (which may include psychiatrist, therapist, family members, etc.) to address: client and family concerns, questions regarding treatment priorities, as well as positive progress towards the clients quality of life goals. On a regular basis, the Case Coordinator will create agendas to address patient’s treatment plans, and establish an organized problem solving platform for all clinicians to discuss potential ideas and concerns regarding patient progress.
Psychiatric Nursing, Nurse Practitioners, and Sober Companions
Psychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia. Nurses in this area receive more training in psychological therapies, building a therapeutic alliance, dealing with challenging behavior, and the administration of psychiatric medication. A growing field in nursing has been in the wrap around care of patients dealing with substance abuse and addiction who are transitioning in and out of residential facilities. They may provide support as a “sober companion” to assist those who are struggling with the re-integration into their former communities.
Substance Abuse Counselors and Interventionists
The main goal of alcohol and drug abuse counselors is to help patients stop their destructive behaviors. Counselors may also work with the families of clients to give them support and guidance in dealing with the problem. Counselors begin by trying to learn about a patient’s general background and history of drug or alcohol use. They may review patient records, including police reports, employment records, medical records, or reports from other counselors.
Counselors also interview the patient to determine the nature and extent of substance abuse. During an interview, the counselor asks questions about what types of substances the patient uses, how often, and for how long. The counselor may also ask patients about previous attempts to stop using the substance and about how the problem has affected their lives in various respects.
Using the information they obtain from the patient and their knowledge of substance abuse patterns, counselors formulate a program for treatment and rehabilitation. A substantial part of the rehabilitation process involves individual, group, or family counseling sessions. During individual sessions, counselors do a great deal of listening, perhaps asking appropriate questions to guide patients to insights about themselves and their destructive patterns.
The professional interventionist is an individual who helps identify the appropriate people in the addict’s life who will be most influential as part of the team that will enable this individual to accept treatment. The interventionist educates and trains the group as well as facilitates the intervention.