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Some of the difficulties regarding integrated versus split/collaborative treatment relate to the following issues: 1) how patients are triaged; 2) who does the initial evaluation and makes the diagnosis (e.g., a referring clinician or resident/attending physician); 3) the experience of the clinician in various types of psychotherapy; 4) the goals, commitment, and resources of the patient; 5) the level of patient understanding of various treatments (either preconceived knowledge achieved through various means or understanding achieved through discussion and psychoeducation during the initial session); and 6) what the clinician(s) can reasonably hope to accomplish. Whether the patient is recommended for integrated treatment or split/collaborative treatment, questions about the type of psychotherapy and medication usage (whether or not to use medication, when to administer it, what type to use) are clearly relevant factors. In this chapter, we discuss the provision of medication and psychotherapy in an integrated model: the psychiatry resident is providing both the psychotherapy and the medication management or other medical care.
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