Why do we, in psychotherapy, include a biomedical assessment as part of the biopsychosocial assessment?
When we think about the biopsychosocial assessment, and the parts that comprise it, we as psychotherapists often struggle with the idea of the purpose of the biomedical component. Many of us might be a little perplexed about it inclusion in the assessment process.
I mean, we’re not physicians, we weren’t trained in addressing medical issues at all. So, why are we working at all in this piece?
I was struggling with whether to write this as a podcast or as a blog entry. So, if this feels a little long, know that I was trying to sort out the best way to discuss this topic. I could have also broken this up into several pieces, but it just feels to me like it belongs all together. I'm just going to encourage you to stick with the topic. Maybe you already think this way, and if so --great!! But I know from way too many conversations with clinicians over the years that many people ask why they need to do this at all. So, in the interest of encouraging this part of the assessment -- here we go.
The purpose of the biomedical component of the biopsychosocial assessment is not for us to diagnose physical ailments, but as a part of the broader aim of us to gain an understanding of the whole person we are treating. The impacts of the physical health of the individual play a vital role in understanding the client, and so assessing it directly allows for us to enter into that discussion with our client at the outset of treatment.
At some level, looking at it from about 10 thousand feet, we’re able to determine how in-tune the client is with their own physical health and how seriously they take their wellness. Are they physically active? Have they seen a physician recently? Do they have a primary care physician at all? Do they have symptoms of something that they’ve been ignoring?
Of course, sometimes a new client arrives to treat something they have identified as a mental health issue, which may actually be a physical health issue and we really want to make sure that they have had the issue evaluated from a medical perspective.
And certainly, understanding the medical history of your client can provide a lot of good information.
For example, knowing that your client coming into treatment as an adult with depressive symptoms he’s experienced since adolescence, along with a certain shyness and difficulty navigating social interactions, had chronic migraine headaches through most of adolescence. This sort of knowledge can come in handy to understand what may have led to the starting point of depression and social challenges.
Add to this the realities of the post-pandemic phase of COVID-19 and the ramifications of “long covid” creates the possibility of addressing a whole range of symptoms that might be better understood when seen through that lens. The Centers for Disease Control, in an article published in 2023, said that as many as 3.4 percent of all adults in the US have symptoms consistent with Long COVID. There is a long list of symptoms that are associated with Long COVID, I’m not going to list that all here. Yale Medicine did a nice piece of the topic, so if you’re curious, I would encourage you to do some reading on the topic. Suffice it to say, current medical and medical history can be vitally important to how you engage your new client.
Along with their own medical history, Family Medical History can provide some great insights into the functioning of the family of your client. Sure, there could be some physical health issues that might be lurking for our client that may be hinted at due to the history of family members. And that may be another place where we might encourage our client to see their physician. To me, there is more helpful information regarding the impacts of the family on the loss of a parent or sibling due to cancer, a heart attack, or accident and the coping mechanisms your client is exhibiting in relationship to that experience. Even when the parent recovers, while there is room for celebration and learned resilience factors, the dynamics of the family can shift as a response to that – or maybe even more stressful – when it doesn’t shift at all, as if “nothing has happened”. Either way, life trajectory tends to be altered through such significant circumstances, and it might be easier for your new client to talk about this from the perspective of family medical history rather than as a functioning piece of family dynamics. Your client may not even be able to articulate it from that perspective. They may not even understand it from a perspective of dysfunction. It “just is” their life situation. This allows them to identify it without being so reflective about it.
We wrap up with a couple of other pieces. First, allergies. Like medical history, allergy history can be meaningful. If you have hay fever -- not much in their world changes. Same thing with allergies to a cat or a dog. You might not have a pet, or you get treatments or take medications, but for most its something to navigate. But if you’re allergic to peanuts your world shifts a little bit. Not just at home, but everywhere. You become hyperaware of the dangers of the world around you. Your parents quickly learn how many things in the world have peanuts or peanut oil in it.
The same can be said for being allergic to bee stings. You make a whole series of life decisions based on that. As an adult you might even change where you might live, vacations you might take, hobbies you might have, based on this simple difference.
The last part of the biomedical review is about medications. Many medications are pretty benign, but others have big life altering impacts. Medications can be expensive, can change the way your body works, and sometime requires how you think about the basics of independence. There are medications you can’t just “skip” or forget without there being some major ramifications, and there can be some psychological impacts. And then there are just side effects. If a client has started a new medication and psychological symptoms have started after that, it might make sense to discuss this with their physician soon.
Understanding our client from a biomedical perspective provides us a with a better and broader understanding of who they are and what their experience has been as they enter into treatment. There are, of course, times when none of these things in this domain come into play in treatment.
But this becomes a straightforward way to rule these items out – which can also be of great help to us as we initiate the psychotherapeutic journey.
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