The treatment field is now confronted with an equally daunting challenge: a skyrocketing degree of acuity and complexity seen in outpatient and inpatient settings alike. Individuals presenting for care with a simple history of alcohol dependence and depression are a rare find in our day.  More typically, patient’s difficulties include a mood as well as an addictive disorder, an eating disturbance of some kind, a history of childhood abuse of some type, along with overwhelming psychosocial disturbances. Where the criteria for full-blown PTSD may not be met, many symptoms of that diagnosis are often present as well. And don’t neglect to look at the patient’s presentation of chronic pain either!

The purpose of this article is to propose an integrated model of treatment to address highly acute and diagnostically complex patients. To accomplish this, I will describe the recent experiences of administrators in a well-heeled psychiatric setting with multiple treatment options within the larger facility. I was one of those administrators and will speak from that experience

Recently, as an administrator in a large psychiatric hospital with multiple program offerings, it became almost impossible to determine which program track would be most efficacious for many newly admitted patients. Given the contents of a pre-admission assessment, conversation among the administrative –clinical team often went as follows: “Should she enter the Mood Program? Well, she is also an alcoholic so she should probably attend the Dual Diagnosis Program. Yeah, but look at her trauma history, shouldn’t she go straight into the Trauma Program and then we can send her to lots of AA meetings and relapse prevention groups at night? You know, maybe we should look at the Eating Disorder Program instead, her eating disorder pre-dated her chemical dependency and perhaps her depression as well. Her depression isn’t going to lift if she continues to be malnourished and significantly underweight…” This may sound like a parody of an admissions team trying to make this critically important decision, but I submit that these discourses are happening everyday, in treatment centers and master treatment planning meetings everywhere. The central question remains: What issues to address first without neglecting or deferring equally important clinical needs?

The answer is that as treatment providers we cannot prioritize in a linear manner – we must find ways in which to integrate modalities that will address the underlying drivers of addictions (both substance and process), behaviors related to said addictions, as well as alleviate the debilitating symptomotology of mood, eating and trauma related disorders.

The TouchStone Model strives to accomplish these tasks with an integration of four specific approaches to care: The modalities include: Dialectical Behavioral Therapy Skills Training as the core foundation , Experiential and Psychodynamic therapies for trauma resolution and processing of family of origin issues, Psycho-Education for denial management and relapse prevention and Life Coaching for mapping a satisfying and rewarding future in health. When these four approaches are integrated and delivered within the context of a structured, motivational and nurturing milieu, the most highly complex and acute patients have an opportunity to experience deep and lasting gains. This model does not preclude adjunct therapies as well: EMDR and Somatic Experiencing provide opportunities for patients to deepen and transform in ways in which they may have previously felt “stuck” despite their greatest efforts and sincere attempts to make therapeutic gains.

This preliminary discussion of the TouchStone Model requires far more elaboration than the scope of this article allows. Clearly, more data will be required to empirically validate the premise that this degree of intensive, integrated work can be tolerated by individuals with acute and complex conditions. However, the initial anecdotal experience of the pilot program of the TouchStone Model at the previously mentioned psychiatric facility suggests that the experiential, psycho-educational and dialectical approaches combined will be an answer to the daunting psychiatric challenges that our patients present.