A Message to Referring Clinicians

To Psychotherapists Considering Referring Patients for a Naturopathic Medical Evaluation and Treatment

Sometimes, when working with a psychotherapy patient, it becomes apparent that he or she is at an enduring and excruciating impasse. In spite of your thoughtful interventions, empathic attunement, and deep compassion – and regardless of the many insights gained and the genuine good faith efforts made by both of you – the patient remains deeply mired in anxiety, depression, disordered thinking, affective instability, or deficits of attention. These periods of impasse happen to every therapist; they've certainly happened to me. Sometimes they are transient, and are resolved though the determined collaboration of the therapeutic dyad. But when they persist, many questions come to mind. Among those is whether the impediment to moving forward is grounded in a physiological imbalance.

On these occasions you may be considering referring out for a medication evaluation. While you know that psychiatric drugs can benefit some patients, you are also probably aware of their profound limitations. You may know that it can take months of trial and error prescribing to find a medication that helps a patient, and then it may have only a mild and short-term effect. You may be aware of the growing body of studies that show that antidepressants in particular offer minimal to no superiority over placebo.

You may have read award-winning medical journalist Robert Whitaker’s recent book, Anatomy of an Epidemic , in which he painstakingly documents with multiple citations to the scientific literature the many serious problems associated with psychiatric medications. In a sober analysis that should shake the foundations of traditional psychopharmacology, he compellingly argues that these drugs often lack efficacy, may produce disabling side effects, and can result in permanent or at least enduring adverse reactions. He also shows how psychiatric medications are sometimes deceptively marketed to patients and doctors, and how arguments for their effectiveness are founded on biased and in some cases scientifically fraudulent studies by authors on the payroll of Big Pharma. And all too often, Whitaker points out, these drugs exacerbate the very conditions for which they are prescribed.

In addition, you probably realize that if there is a physiological component to a patient’s psychological suffering, psychiatric medications, even if helpful, are not going to treat the cause. Similarly, you may be aware that the patient has one or more chronic medical conditions that are not being well managed, or are being treated only symptomatically.

Many diagnostically distinct conditions, like depression, cognitive impairment, cardiovascular disease, autoimmune disease, and arthritis can be linked by shared etiological mechanisms such as low-grade systemic inflammation, impaired intestinal barrier function, oxidative damage, hormone dysregulation or nutrient deficiencies. Patients referred to the Mind-Body Clinic will undergo a comprehensive assessment that is designed to identify these underlying imbalances, so that any physiological treatment of their psychiatric and other chronic conditions is informed by objective data. These data – laboratory findings, as well as a thorough history – are what enable naturopathic clinical interventions to be tailored to the specific biology of each patient.

I respect and am committed to protecting the integrity and uniqueness of your relationship with any patients whom you might refer to me. This means that while psychotherapy is a central component of my integrative approach with some patients, my role with those individuals sent by referring clinicians will be limited to addressing the physiological impairments that may contribute to their mental health difficulties. In addition, one of the services I provide is an elaborate written report of findings and treatment plan that puts all the data and their implications into a clear and coherent narrative that can be understood by both the patient and the referring therapist. Beyond that, assuming they grant permission for me to do so, I will make myself available to consult on any patient whom you may send to my clinic.

To Medical Practitioners Considering Referring Patients for Psychotherapy or Naturopathic Care

Whenever possible, my preference is to work collaboratively with any referring clinician. This includes prescribing psychiatrists, acupuncturists, chiropractors, and primary care providers like naturopathic doctors, family practice physicians, internists, and nurse practitioners. Should a patient be on any medication, nutritional regime, or other clinical protocol, I will make every effort consult with the prescriber regarding notable laboratory findings and treatment recommendations. Referring providers can be confident that I will not unilaterally recommend discontinuation or any change in dosage of a patient’s prior treatment without first attempting to confer with the clinician who formulated that treatment.

If you are referring a patient for only psychotherapy, and are wishing to be the sole provider of their physiological care, you can be assured I will delimit my work to the psychotherapeutic domain. To the extent that the patient wants us to share information, signs an informed consent, and in my judgment such a consultation is in the patient’s best interest, I will gladly do so.

Dr. Ducat

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