Collaboration NOT Competition

Posted on Friday, February the 8th at 12:01am

Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

There is a systemic problem that sabotages effective treatment for anyone with an addiction problem, but especially people with chronic pain and coexisting disorders.  It’s called Competition!  In my experience of working with this population, an integrated, multidisciplinary treatment approach is vital to the success and effectiveness of pain management recovery.  But everywhere throughout society competition reigns supreme: in politics, sports, and relationships.  It’s fundamental to our American economy and the foundation for every reality program on TV today.  Regrettably, in the treatment field, it often develops into what I call “Turf Wars” between healthcare disciplines.  It is also a dynamic that occurs when one agency “competes” with another in order to build their treatment census. 

Sadly, the reality is that there is enough pain and suffering in this country, in fact so much that there are not enough treatment beds for everyone who needs our help.  It is estimated that there are over 11 million people in the United States alone who have developed a substance use disorder—either abuse or addiction—as a result of living with a chronic pain condition.  Our current system of treating just chronic pain does not offer access to quick and effective treatment and as the population of people with chronic pain grows, this problem will only worsen.  This is especially true when someone develops an addictive disorder due to prolonged exposure to psychoactive pain medication.  If we really want to contribute to the health and healing of these people, the treatment community must create a new paradigm that values collaboration over competition. 

Many times when I consult with an agency I discover either overt or covert dissension occurring between the treatment disciplines.  Employees often feel threatened or criticized by each other or management and the level of communication is poor and ineffective.  More often than not this is a system problem, not a people problem.

I remember the first time I experienced this inter-disciplinary dissention as the primary therapist for chronic pain patients at an inpatient addiction treatment hospital.  As I worked with medical, mental health and other addiction counselors, I noticed how often they put each other down in subtle—and not so subtle—ways.  Misunderstanding and jealousy reared its ugly head as team members challenged me with their conclusion that pain patients were receiving “special” or preferential treatment.  In reality they had “special” treatment needs that were specific to their pain which had to be addressed.  Fortunately the two medical directors were savvy regarding “turf-war” mentality and worked with me on ways to educate the treatment team to work toward collaborating with each other. 

When I dug deeper, I discovered the front line nursing staff often saw patients as complainers and “drug seekers.”  I worked with the medical directors to support nursing staff to understand their patients better.  What we helped them see was that the patients were not drug seeking in the conventional sense, but rather seeking relief from their pain; they just had not been taught how to find relief in a healthy and safe manner.

The addiction counselors and mental health professionals on the other hand needed to learn why the medical team operated the way they did.  The clinical team often expressed their anger when the medical staff pulled patients out of “important” clinical activities.  The disciplines were not working together to make sure the patients had their needs met in the most efficient way possible. 

Over the course of a few months we had a representative from each discipline take turns conducting in-service trainings so that other team members knew what they did, how they did it, and why they implemented the treatment interventions they did.  Within a few months we began to see attitude changes among the staff.  What solidified the learning was an agency sponsored team building retreat away from the hospital.  We had such a positive experience that we came back as a true treatment “TEAM.”

This is why team work is so crucial.  We need to work with the whole person, which means treatment plans for the biological, psychological, social, and spiritual domains.  This can best be accomplished by using a truly integrated multidisciplinary treatment team with the patient being the Captain of the team.  We need to work with patients—not on them.

Over the years I have conducted many Addiction-Free Pain Management™ (APM) trainings for agencies that included every treatment discipline.  I am always cognizant of the need for teamwork and break participants into random multidisciplinary groups that support them to work collaboratively with each other on different problems or learning skills.  By the end of the training amazing results occur.  I want to share with you one of the endorsements I received last year from Dr. Bernard S. Sobel, Director of Psychiatry - Valley Forge Medical Center & Hospital.

"Dr. Grinstead has given an unanticipated 'gift' to our staff:  The melting of Staff-Turf disciplines into a cohesive working and interacting 'Total Team!'  Over the past few years the 'Team Work' process had deteriorated. The APM training actually became a healing and integrating process. Recent new staff and long term staff melded.  The content and the delivery were essentially flawless.  Your agency/facility would benefit from involvement with Dr. Grinstead."

Negativity and confusion is often the result when competitive or turf-war mentalities surface between treatment disciplines or agencies.  In the end, potential patients are always the ones who suffer.  Remember, there is enough pain and suffering in the world—let’s not add to it by competing with each other.  Let’s collaborate and provide the best possible treatment for everyone with chronic pain and coexisting disorders who needs and wants it.