By: Gray Otis, PhD, LCMHC, DCMHS-

How Do Counselors Assess Integrated Behavioral Health?

Drawn from part of the Counseling Tips on page 14 of the Summer 2019 issue of The Advocate Magazine When Lisa first met Eli, a licensed clinical mental health counselor (LCMHC), she said, “I don’t know what’s wrong with me. I am either anxious or sad all of the time.” After exploring how she experienced her symptoms, Eli asked her to tell him about herself. This open-ended question led Lisa to recount being raised by somewhat demanding parents, her divorce two years previously, and her concern about feeling nauseous much of the time.Because Eli was trained in integrated behavioral health, he conducted a wide-ranging evaluation of Lisa’s overall wellness and psychological well-being. LCMHCs understand the importance of whole-health assessment as well as the growing requirement to collaborate with primary care providers (PCP) and other medical professionals.One of the ways we LCMHCs can accomplish an inclusive health appraisal is to follow the step-by-step approach of the HEART Assessment. This approach includes a review of five essentials of total health. The first letter of each of these five essentials forms the acronym HEART*:

• Health – physical wellness based on the principles of healthy living

• Emotions – emotional balance through affect regulation and self-understanding

• Awareness – cognitive engagement through the conscious use of mental abilities

• Relationships – interpersonal effectiveness through satisfying connections with others

• Transcendence – enrichment through inspiring and uplifting influences

(*The “HEART” model is part of the book “Key Core Beliefs: Unlocking the HEART of Happiness & Health,” www.KeyCoreBeliefs.org.)

All five of the essentials interact with each other in mutually supportive or mutually disruptive ways. When these essentials are predominately detrimental, we are more likely to face problematic concerns that increase negative beliefs about who we are. When these essentials are primarily constructive, we become more resilient, develop richer relationships, and reinforce positive beliefs about ourselves. Additionally, if one of these health components deteriorates, the other four areas will often be adversely affected. For example, over time, inadequate sleep will significantly impact physical health, and it also negatively affects emotional regulation, cognitive functioning, and our ability to feel connected with others. As Eli worked with Lisa, he went deeper into the HEART essentials, reviewing with Lisa her:

• Health – nutrition, hydration, sleep, exercise, medications, substance use, etc.

• Emotions – emotional lability, affect regulation, distress levels, ACE, past trauma, etc.

• Awareness – mental status examination, cognitive engagement, learning, hobbies, etc.

• Relationships – connections with family and friends, interpersonal effectiveness, etc.

• Transcendence – mindfulness, meditation, faith, enriching or uplifting experiences, etc.

After reviewing these areas with Lisa, Eli was concerned about an automobile accident in which Lisa’s car had been totaled, but she had walked away with just dizziness and a severe headache. Because she had no external injuries, she had not sought a medical evaluation. Although the headache subsided, she often felt like she was in a mental fog. She also reported that prior to the accident, she had been in an emotionally problematic relationship. Her spouse’s almost constant criticism of her ultimately led to separation and divorce, which devastated Lisa. She came to believe that she could not never trust a committed relationship.Lisa told Eli that she felt relieved just to tell someone how confused and upset she had become. Eli suggested that she see her PCP for an evaluation. He was concerned that the car accident might have caused an undiagnosed concussion or other neurological condition. His concerns were well-founded. After a blood clot in her brain had been located and surgically removed, nearly all of Lisa’s anxiety and depression symptoms were alleviated. With her consent, Eli coordinated with her doctor to ensure adequate psychological and medical follow-up.Lisa also continued to see Eli to work through her anxiety about trusting in committed relationships. Her key self-belief that she could not confide deeply in anyone was transformed into a renewed self-belief: “Because I am perceptive, I am confident that I will know when I can trust someone.”Had Eli had not referred Lisa to her primary care provider, the blood clot might have resulted in a far more injurious outcome. Today, LCMHCs like Eli are becoming recognized as integrated behavioral health care specialists. In addition to the skilled therapeutic work LCMHCs do, all mental health professionals can undertake additional education and training to become more adept at assessment, referral to medical providers, and coordination of care. 

“Key Core Beliefs: Unlocking the HEART of Happiness & Health” is available from Amazon.com. Gray Otis is a licensed clinical mental health counselor and an AMHCA Diplomate & Clinical Mental Health Specialist in Trauma. A past president of AMHCA, he has a private practice in Cedar Hills, Utah. He is also the primary author of the 2018 book, “Key Core Beliefs: Unlocking the HEART of Happiness & Health,” which was written for both mental health professionals and members of the public. Learn more at KeyCoreBeliefs.org, and email him at gray_otis@yahoo.com.