Therapists read and prepare a number of treatment plans for mental health conditions. In terms of goals, and objectives selected – both of which are used for evidenced-based treatment planning – I notice: ‘symptom management’ written down on paper or on the screen of an electronic health record (EHR).
What is symptom management, exactly? Symptom management is commonly defined as the prevention or treatment, as early as possible, the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment.
As a seasoned therapist and mental health advocate for recovery, the belief or understanding of symptom management as a viable or appropriate goal for any mental health treatment plan is not only an active disservice to the patient in question, but it also speaks to the philosophy of care and provision of services being provided by the therapist prescribing it.
Symptom management is also called palliative care and supportive care. Under the medical model, and provision of care of a medical doctor, this might be appropriate. Sure, terminal cancer patients and people who are at imminent risk of death, should always consider palliative care and symptom management to control pain and other intrusive symptoms as a result of their medical condition. But for the purposes of treatment planning and treatment of mental health conditions, the implementation of any symptom management course of treatment is consigning patients to a life without hope of progress, improvement, or any real healing.
Under my supervision in the Courtlandt Avenue Mental Health Clinic, in which I oversee half a dozen master’s level MSW (master of social work) and bachelor’s level BSW (bachelor of social work) interns, symptom management is simply not an option for treatment planning purposes or an acceptable practice for the treatment of their patients with mental health disorders. Goals and objectives in a patient’s treatment plan should always be something achievable, positive, and person-centred at the very least.
As therapists driving treatment forward, this is what we need to be interested in for our patients as an unquestionable anchor of care. The belief that symptom management is driving treatment forward, or even in the best interest of patients with a mental health condition, is simply fallacious. Why shouldn’t the patients we treat hope to achieve anything better than the ‘new norm’, in terms of the quality of their mental health status, or expect to experience improvement?
The new norm! Patients don’t want to ever, ever, hear this from a doctor. Meaning, get used to this condition because it is permanent. As a person who has recovered from schizophrenia, who was told by doctors, to ‘take it easy’ and that I should not get too stressed because I might relapse; I have never listened to this rubbish passed off as clinical insight into a mental health disorder. I knew better, and when I was told to relax, I was already registering for graduate school in social work. But far too many people listen to their mental health providers and really internalise misinformation about their health condition. The result of such listening and internalisation can be tragic for people who consign themselves to a lesser meaningful life because some therapist or psychiatrist misidentified their patients potential for success and healing.
I am going to assume for a second, given conversations I have had with other mental health providers, and even my students, that thinking the very idea of a ‘new norm’ fits into a person-centred paradigm, is just misinformed. I am also going to assume, on the level of language and writing, misusing the term symptom management is also a gross misuse of terminology.
I really don’t believe this explanation for a second, though. Why? Because so many people are doing it! Sure, many people, even skilled and knowledgeable providers are under the guise of false assumptions and misinformation. But surely, is misinformation traversing the mental health practitioner community at such deep and insidious levels? Maybe.
More likely though, practitioners that use this terminology in their practice are heading towards burnout, experiencing compassion fatigue, or have simply lost sight of their belief in recovery and healing for their patients. For patients with a vested interest in their recovery and hope that they will experience progress in their treatment, the time has come to readjust your clinical gaze and start to expect better outcomes for your patients.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.