Psychodynamic systems of residential treatment: another view from Riggs

Harnessing the Synergy Between Mindfulness and Psychotherapy

This column explores mindfulness as one part of Buddhist teaching and practice that has attracted attention in the treatment of mental and substance use disorders. Cognitive neuroscientific correlates of mindfulness are presented. Mindfulness is offered as a potentially valuable technique that can not only help patients in individual psychotherapies endure the painful emotions that are part of psychotherapy sessions and of managing life between sessions but also help patients and clinicians across modalities move beyond adherence to particular techniques that focus primarily on symptom reduction, to better meet patient needs and improve treatment outcomes. This column explores elements of a mindfulness coping skills group used in a residential treatment setting that emphasizes intensive individual psychotherapy in a psychodynamic system of care.

Clinical and Insurance Perspectives on Intermediate Levels of Care in Psychiatry

This column compares a clinical perspective on the continuum of care for mental health and substance use disorders with a different perspective derived from publicly available insurance company documents and experience dealing with managed care utilization reviewers. The latter perspective tends to determine the need for access to levels of care based on the need for crisis stabilization, whereas the generally accepted clinical standard is more nuanced than the need for crisis stabilization alone. The column proposes that this discrepancy in perspectives makes a substantial contribution to disagreements between treating clinicians, such as therapists, and insurance utilization reviewers concerning the medical necessity of various requested levels of care.