Over breakfast recently, my Naturopathic colleague, Felicity Leahy, and I mused over our first year of working together. Here is our Q&A session.
How did you start working together?
Karen: It felt quite serendipitous. At the start of 2016, I had just moved to Wellington to set up my integrative psychology practice, a service for individuals who experience overlapping physical and mental health concerns. I was on a quest to find likeminded health practitioners to work with from the physical/nutritional perspective with my clients. As it often happens when you are looking for something, I was soon after introduced to Naturopath and Clinical Herbalist Felicity Leahy, who had recently set up her naturopathic clinic. We initially met for a cup of peppermint tea, and I immediately felt a strong connection. I liked that Felicity shared my passion for assisting people with chronic health problems at a practical level, was looking for interdisciplinary support, and was also a relatively new graduate developing her clinical practice.
Felicity: A shared patient brought us together. Karen had advised that she seek out some support for her chronic gastrointestinal symptoms due to the possibility they were contributing to her emotional challenges. At the time it had been rare for me to encounter practitioners outside naturopathic medicine who saw the interconnection between the body and the mind and who actively encouraged patients to educate themselves on the connection and take steps to improve it. I remember being excited and thinking “I like the sound of this psychologist!” I got her details from the patient, got in touch and our collaborative relationship was born.
Why Work Together?
Karen: As a clinical psychologist, it's outside my scope of practice to address things that have a physical origin or contribution. However, because my core clientele have gut-brain-axis dysfunction, physical, dietary, and lifestyle interventions are necessary in order for them to fully recover. I thought about retraining as a medical doctor or nutritionist, but after the13 years I'd already spent at University I was reluctant to sign up for another stint! Instead I took another training avenue - nutritional medicine - and I worked to connect with similarly trained practitioners from medical disciplines, and thankfully came across Felicity who is trained in both natural medicine and nutrition. It's been my experience and observation that when it comes to chronic health problems that natural medicine approaches have 1) the time and capacity to hear a persons story not just their symptoms, and, 2) broader tools to offer than those which are available to a GP whose focus is often (but not always) diagnosis and medication. Diagnosis and medicine can be helpful and life saving at times - however when it comes to chronic health problems these can fall flat because of the jigsaw puzzle nature of such predicaments, and the multifaceted pieces required in recovery. This nearly always involves a combination of a compassionate ally and dietary and lifestyle modifications. Felicity and I also work with other specialists as indicated by the wishes and the specific health needs of the individual.
Felicity: One of the key principles of naturopathic medicine is “treat the whole person”, which means the naturopathic physician must take into account the complex interaction of physical, mental, emotional, spiritual, genetic, environmental, and social factors that determine health or disease. Over the course of assisting an individual with their health concerns, it often becomes clear that mental, emotional and spiritual factors may be a significant contributor to physical health challenges. Where these are of a significant nature, a referral to Karen is the next logical step. Like Karen, I have a scope of practice that I adhere to and am trained to refer to an appropriate health professional (GP, psychologist, physiotherapist etc.) when the treatment needs fall outside my scope or a speedier resolution may result with another practitioner’s involvement.
Who Benefits from Combining Psychology and Naturopathy?
Karen: At least 1/3 of my clients also see Felicity for assessment and recommendations. Indications for a referral to her include 1) testing and addressing common nutritional deficiencies that can appear as, or worsen, common psychological disorders like anxiety or depression (e.g., B12, zinc, or iron deficiency - and finding out WHY they became deficient); 2) explore gut health issues at a deeper level (e.g, find the cause of "IBS" symptoms and heal the gut); 3) resolve hormonal disharmony (e.g., adrenal dysregulation, thyroid problems, and sex hormone imbalances); 4) support stress, anxiety, emotional, and cognitive concerns through dietary modification, targeted herbal medicine, and nutraceuticals (vitamins and minerals) that promote optimal neurotransmitter, endocrine, and immune functioning; and, 5) for specific health condition recommendations (e.g., autoimmunity and other acquired inflammatory health conditions). Other helpful criteria include if the client wants to take a natural medicine approach, if they are looking for a root cause analysis rather than symptom management, and their motivation or willingness to put in place diet and lifestyle changes.
Felicity: Yes all of the above. I’ve also seen patients who were struggling to maintain healthy habits and behaviours experience enormous benefit from combining approaches. Successful naturopathic treatment requires behavioural change by the patient. Someone may need to improve their diet, start an exercise programme or take some herbal medicine daily in order to see improvements in their health. But changing habits of a lifetime can be hard! Sometimes, despite our best intentions, we’re not able to consistently put these habits in place and so treatment stalls. With gentle inquiry we often discover that thoughts, emotions or beliefs are getting in the way of making positive change. Psychology can be a way to uncover and clear deeper blocks that were getting in the way of progress. Sometimes a single session with Karen has been enough to catalyse a shift in an individual who was feeling completely stuck.
How Do We Work Together?
Karen/Felicity: We refer clients back and forwards for specific input from the other clinician's skill set. With our clients consent we send a summary of our assessment to streamline the other clinician's assessment process, and then reciprocate with sharing our respective treatment plans so that we work the best we can together. We also liaise and hold meetings, periodically review treatments plans, reinforce similar messages to clients, and share relevant resources. A common example would be clients with adrenal dysregulation - they may have come to me (Karen) due to chronic stress, and over the course of my assessment the degree of physical symptoms may be above and beyond that which can be remedied through psychological intervention. Through referring to Felicity she would be able to further assess adrenal functioning, and provide a plan which provides the physical support for the person to be in the best position to become involved in therapy work or lifestyle change. In therapy, this may include looking at how they became chronically stressed in the first place such as personal beliefs, expectations of themselves, difficulties in relation to others, or aspects to do with their internal dialogue (e.g., being highly self-critical, anxious rumination, or avoidance of emotional experiencing).
Felicity: There are some classic presentations where both naturopathy and psychology can bring about a quicker improvement than either could achieve alone. These are the top three that I encounter in my practice:
- When gut issues (IBS, bloating, loose stools, constipation, food intolerance etc.) present alongside psychological difficulties – due to the complex signalling that occurs between the gut and the nervous system.
- Chronic stress and burnout (also known as adrenal dysregulation) – this almost always includes profound physical symptoms which naturopathy can help address, but also needs therapy to address ways of thinking or personality characteristics that may have contributed to the situation. Many of my patients may recover quickly from this but find themselves in the same situation a few years down the track. This is why addressing the psychological drivers is so crucial.
- Anybody experiencing emotional or psychological distress who struggles to consistently eat well. They may have had poor nutrition since childhood. The evidence that nutrition impacts mental health continues to grow, and in addition we know that micronutrient levels in food dropped significantly over the course of the 20th century. An apple contains only a third of the iron levels that it did in 1940, so we need to eat better than ever before to maintain optimal mental health.
Karen: Ditto to these top three, and I have also found great benefits in referring clients living with the effects of trauma, experiencing panic attacks and specific types of anxiety, as well as low mood and emotion regulation challenges. Even with what appears to be quite straight-forward psychological symptoms by nature can have an incredibly body-based cause and solution required - such as panic attacks caused by hormonal mayhem. The dual roles of naturopathy and psychology seem to have a synergistic effect.
"Synergy: The combined effect of individuals in collaboration that exceeds the sum of their individual effects." ~ Stephen Covey
What is the most Beneficial Aspect of the Other's Role?
Karen: I'm not sure how I'm going to pick one thing here! But I would have to go with the depth of evidence-based knowledge that Felicity has about the body as a whole system rather than it's component parts, and then logically what that system needs from its environment in order to heal. This allows the capacity to think about root causes of symptoms that the health care system has tended to boil down to individual parts, rather than an integrated whole. I always learn more from Felicity with each new case that we work with together. If I can pick a second thing, it would be her capacity to connect, listen, and offer compassionate and practical guidance to wildly diverse clients of different ages, ethnicity, and backgrounds.
Felicity: Yes, I agree – too many to list! One thing I hugely value is Karen’s use of Acceptance & Commitment Therapy, a mindfulness-based approach. This aligns with my own experience of what helps most to get people well. I consistently see that patients who incorporate mindfulness or meditation of some kind alongside nutritional and lifestyle changes recover more quickly than those who don’t. The reasons for that is a whole other blog post, but I’m interested in finding the most direct route to healing for the people who come to me for assistance. I believe the tools that Karen can introduce to people’s lives are powerful and life-changing. But its not just me that believes this – Karen’s patients frequently tell me this themselves.
On the Value of Mindfulness
Karen: There has been a recent trend of mindfulness-bashing, which appears to be partially fuelled by mindfulness-washing and using mindfulness as a buzz word or to profit from. My own definition of mindfulness has been derived from a therapy mode called Acceptance and Commitment Therapy (or "ACT" - developed by Steve Hayes and colleagues) coupled with Compassion Focused Therapy, and involves being able to be present, non-judgementally and compassionately, with your emotional, cognitive, and physical experience whether this is pleasant or unpleasant, when it's useful to be, and to do what matters in response to this experience, in accordance with your values. This doesn't have to involve striving for a Zen like state, unless that's is considered helpful, and can be done in any moment without any resources other than yourself. There is plenty of evidence for this brand of mindfulness as an effective approach for navigating life with an old brain in a rapidly evolving time.
- An excellent podcast for educational information about chronic health difficulties is Chris Kresser's Revolution Health Radio. Chris is empathic, non-alarmist, practical, and evidence-based.
- Women's health psychiatrist Dr Kelly Brogan is paving the way in treatments for inflammatory health conditions that are commonly misunderstood as psychiatric. She blogs and shares videos, and recently edited a book for practitioners as well as a guide for individuals who want to take back control of their health. Check her out here.
- The research work of NZ's Professor Julia Rucklidge and the Mental Health and Nutrition Research Group and Australia's Felice Jacka The Food & Mood Centre are both great sources of information about the emerging evidence base for nutritional interventions for mental health.