KINGSTON, R.I., -- February 8, 2001 -- A family learns that a terminal disease is killing one of its children. In the past, that family would receive the information from a doctor, and then would often proceed without working with a mental health professional to deal with the emotional issues.
Mara Berkley, a visiting professor of human development and family studies at the University of Rhode Island, has been working to change that model so more comprehensive and collaborative teams of health professionals come together to provide the most effective care.
Berkley, who holds a doctorate in psychology from the Massachusetts School of Professional Psychology, argues that teamwork based on a holistic view of the patient is the best alternative for patients suffering from Acquired Immune Deficiency Syndrome (AIDS), depression, eating disorders, and intestinal conditions.
In fact, she would like to see pediatric physicians include mental health professionals on their teams so when children receive annual physicals, they would also get mental health checkups.
Berkley details the success of such a model in an article in the new edition of Families, Systems & Health, The Journal of Collaborative Family HealthCare. The journal maintains that mental and physical health are inseparable when dealing with most illnesses and that families are the foundation for providing health care.
Her story of Keith, a gay client living with Ashley, who is HIV positive, addresses how she worked with Keith to bring Ashley into therapy and then to seek medical treatment. The case study is from work Berkley did while a marriage and family therapist in Oregon in the1980s.
Berkleys husband, John Straus, a medical doctor specializing in holistic medicine, referred Keith to her. Keith was being treated for trouble sleeping and nervousness, symptoms Straus did not believe had any physical basis.
"Our collaboration grew from a desire to treat the whole person, which in the early 80s was a euphemism for holistic medicine," said Berkley, a member of the Rhode Island Association for Marriage and Family Therapists. She and Straus met weekly to discuss patients, and also referred them to an acupuncturist, massage therapist and other body workers.
Berkley says in her story that Keiths therapy lasted six weeks, and that Ashley was already HIV-positive when he and Keith met. However, Ashley was symptom free. Keith was angry and troubled that his partner was so cavalier about his health. At the end of a particularly painful session, Ashley decided to enter therapy, and soon after took steps to protect himself from developing AIDS. Keith and Ashley separated but maintained a loving friendship.
"From this experience, John and I learned about the power of collaboration, how by combining differing ways of conceptualizing disease and treatments, patients can be helped to overcome resistance to treatment and to use their inner resources to become proactive in their medical care," Berkley writes in the journal.
Berkley and her husband now live in Bristol with their 11-year-old son JustinMichael. They no longer practice together, but they continue to use collaborative approaches in their work. Straus is running the addiction unit at Roger Williams Medical Center in Providence. Berkley said most of the literature on collaborative health care remains in the physicians arena. "This is the first article in this journal written from the perspective of a mental health professional and a holistic physician," Berkley said.
She said the case of Keith and Ashley is just one of many in her book, Flying Lessons: A Memoir of a Family Therapist, she hopes to have published.
Many of the books stories document patients reporting that they felt better just by talking about their problems and medical issues. "We could address psychological issues getting in the way of treatment, and we could bring in support resources," Berkley said.
One case involved a woman who had been depressed for 18 years who first saw Berkleys husband. He then referred the woman to Berkley. "In less than a year, we helped her get better. This is a woman who wouldnt leave the house, would stay in her pajamas all day. She began resuming regular duties without the benefit of drugs."
She said she and her husband successfully treated a man with Crohns disease and helped a woman with a terminal disease help her husband deal with end-of-life issues.
"My father died when I was 25, and no one ever talked to me," Berkley said. "When people are able to process issues from their family history, they can make healthier choices.
"The collaborative approach has worked well with children suffering from diabetes and asthma," she said. "My goal in the future is to work directly with physicians," Berkley said.