Health-Related Issues In Therapy

Physicians and therapists are developing a deeper understanding of just how interrelated physical wellness or illness is with emotional fitness. It is an experience that patients live with. However, it is often under-addressed because of the limitations of a physician’s scope of engagement with their patients and the challenges of collaboration between doctors and mental health providers, which is necessary to fully integrate the physical and emotional aspects of life.

Individuals with health challenges–whether chronic or acute–bring particular needs to therapy. Choosing a therapist with experience navigating those issues, who understands the ways those health issues interface with your emotional life is critical.

While the overlap between medical and emotional issues is vast, we bring a particular focus to pain, trauma, treatment compliance, helping resolve grief that may be contributing to a health challenge, understanding and addressing psychosocial issues that affect quality of life, helping individuals accept a diagnosis of chronic illness of themselves or a family member, engaging family members and other caregivers, and psychological or emotional challenges that may compound recovery or obscure the proper diagnosis of a medical condition.

The therapists at TriBeCa Therapy can become members of your health team: Coordinating care with doctors, physical therapists, nurses and other health care providers so that your emotional health care is a seamless fit with the other aspects of your health care. With your consent, we stay in touch with health providers to develop a treatment approach that complements their care.

Your Health Team

Our family systems approach prioritizes an understanding of health challenges as located within a system of people. It has helped us develop protocols that anticipate problems and empowers that system to work together on behalf of mitigating health challenges and promoting good health outcomes. In medicine, the term “health team” typically refers to the set of medical providers involved in a patient’s treatment and recovery.

At Tribeca Therapy, we take this a step further by identifying friends and family members who the patient invites to be a part of a team that participates in health care, recovery and financial decisions. These individuals can offer practical and emotional support, be available to attend meetings with physicians and other health care providers and be on call to provide child care, practical support and relief to key family members in the event of an emergency or overnight hospital stay. The strategy, here, is to formalize the community of people who are already willing and available to take some of the pressure off of intimate partners or key family members. This can help anticipate health-related events that might put pressure on a family by formulating a plan to help manage that pressure.

Trauma

Often the first stop following a traumatic injury is a hospital or urgent care clinic. Doctors and nurses stabilize the injury and get you back on your feet. But then what? While you may find yourself physically on the mend, traumatic experiences leave a powerful mark that can last well past the time it takes the body to heal.

Sometimes the very interventions used to keep us alive or set us on the path to healing can be traumatic themselves. When we’re medically at risk, we are grateful for these interventions, but they can be—necessarily—painful and rough, or perhaps leave us in fear of losing our lives or living with impaired physical or cognitive functioning. Many carry trauma forward from these experiences.

The first task of trauma therapy is to establish safety and end the crisis. Just as the medical team’s job is to stabilize the patient medically, our job is to establish emotional stability. The process of recovering from trauma can’t and shouldn’t begin until the trauma has fully passed.

While each case is unique, those experiencing health-related trauma often struggle with a sense of having been powerless and unable to protect or care for themselves, as well as a sense of loss (of independence, of health, of a sense of invulnerability). The incident itself, whether a trauma that led them to seek medical intervention or even, the intervention itself, may have been painful and frightening or filled with uncertainty. Revisiting these emotional experiences from a place of safety with the help of a stable treatment partner is critical to managing or preventing the symptoms of PTSD, which, in addition to the obvious mental health benefits, can also improve health-intervention outcomes and compliance with a rehabilitation plan.

Taking your pain or fatigue seriously

There are a number of medical issues that cause chronic pain or fatigue and these are not always fully understood. While pain and fatigue always have an emotional component, these challenges are too often seen as “all in your head.” We recognize that pain and fatigue are very real and advocate for patients to receive the best palliative treatment, including prescription painkillers when appropriate. Our work is not intended to replace medical attention for pain but to supplement it–to look out for potential hazards of abuse and to expedite holistic recovery to help lessen the duration of time for which a patient will need these drugs.

While great medical or surgical care is essential, pain is also a deeply subjective experience. Effective therapy can help manage your response to pain, using a life-wide approach to reorganizing emotional and practical habits that may influence and be influenced by pain. This can dramatically reduce the subjective experience of pain and increase our ability to manage it.

A life-wide approach means not just treating the symptoms, but understanding them contextually. Trauma itself, as well as many of the consequences of serious medical interventions and vulnerability, can change relationships with partners and family members, can require a loved one to step in as a caretaker and can change expectations for life and career. Even when these experiences are temporary, their implications can be lasting without proper help. All of these psychosocial distresses can impact the subjective experience and the duration of physical pain.

Issues related to conception, pregnancy, childbirth and postpartum depression

Several of our therapists at Tribeca Therapy have long provided an assortment of services related to difficulties with conception, miscarriages, family planning, pregnancy and childbirth and postpartum challenges, including postpartum depression and postpartum anxiety. In nearly all instances, issues related to health, including complications with conception, pregnancy or birth, impact psychological health in and around these issues. We support both moms and families as a whole in tackling these issues.

Grief and loss

Medical providers often have a front row seat on their patients’ experiences of grief and loss and often provide acute psychological help for those struggling with these challenges. Grief and loss often play out over time, and some of the complications related to grief may not present until well after the medical treatment or hospital stay has ended. With ongoing psychotherapy–either short-term or long-term, patients can be guided through a process of understanding their experience and finding peace with loss.

It is important to note that the passing away of a loved one is not the only manifestation of this grief. Individuals can grieve the loss of certain physical functioning like the loss of a limb, cognitive impairments, changes in sexual functioning and a loss of independence. These losses are less often categorized as grief, but nonetheless may require professional attention.

Chronic illness

A chronic illness can bring with it special demands beyond those of an acute illness. The process of grief is likely more significant–reconciling oneself to a lifetime of limited functioning and/or medical treatments. Compliance with these treatments is especially important. Patients need help to accept the illness and its implications while discovering what is possible even if it’s not what they had planned.

A chronic illness also affects family members as they need to adjust to a caretaking role, new financial realities and changing expectations for their own lives. When necessary, a family systems approach may be needed. In such cases, health difficulties and trauma are conceived as not happening simply to one individual, but lived and experienced by everyone in their family–with family defined in whatever way is meaningful to that patient, which can include caretakers and friends.

Death and Dying

Facing mortality is an inevitable part of medicine and physicians are often on the front lines, bearing witness as patients and family members grapple with a loss or pending loss. While physicians receive training in palliative care and in providing support to patients and family members, the need for grief-related treatment often exceeds what a physician’s office can provide. Working with individual family members on emotional issues related to death, as well as the practical steps involved in making end of life plans, is an area of practice in which we are fluent.

What our therapy practice can do:

We speak doctor

Coordinating our care with physicians is a standard part of our practice. With our patients’ consent, we share progress and concerns that may inform medical interventions. When relevant, we can provide concise case notes in written form so that we communicate with busy doctors who may not be available to meet by phone. We understand the nuances of health care delivery and work in a manner that is designed to complement those services.

Sticking to the program:

In order to be successful, many medical interventions require patients to continue to comply with a course of treatment outside of the hospital or provider's office. This can include physical therapy exercises or exercise more generally, medication compliance, diet and consistently making it to appointments with medical providers. We work with children and families on challenges related to health maintenance, restrictions that require a child to grow into new behaviors or cooperate with physician instructions that may feel burdensome or embarrassing, such as checking blood sugar, wearing a back brace, being vigilant about avoiding certain dangerous foods and avoiding physical activities that their peers enjoy.

Breaking out of the 50-minute, one-on-one mold

In most cases, there’s a good reason that therapy takes place as a private, 50-minute session between you and your therapist. However, when complicated health issues are present, we have to be willing to step outside that convention. When appropriate–and with your consent, we may recommend inviting caregivers, family, or friends into the session. We may also encourage phone sessions when leaving the home or treatment center is prohibited and work to establish mental health supports beyond psychotherapy.