Counseling Complexities & PIE?

Photo: Annie Spratt on Unsplash.com

PIE literally means Person in Environment¹⁷. The PIE perspective is an effective method to assess mental illness (and to rule it out) because the person is viewed from interactions and relationships in the environment as a primary consideration. PIE is most commonly used by Clinical Social Workers. Where a person works, lives, learns and plays must be interpreted when assessing “abnormal” responses; consideration of the many systems in a person’s life (including their physical health) matters prior to labeling mental illness. Medical conditions can certainly be the root of what originally appears as a mental illness—and a trained mental health professional who uses the PIE method considers etiology. Etiology may include illness; it may also consider things like nutrition and hormonal influences, aging and exercise impact, genetics and ways that brain works (both in illness and in health).

Whether there is clinical evidence of a mental illness, diagnostics of certain disorders (life long ones in particular) may require the psychometric testing of a clinical psychologist (consider who should I see and other professionals for more information); in some cases a psychiatrist is needed for prescriptions. But in talk therapy (CBT, Hypnosis, Cognitive Challenging, Supportive, Motivational, Coaching, Mindfulness and other approaches of varying kinds), with an expert who knows and understands the person in environment (PIE) perspective, many factors can indicate problems OTHER than mental illness; in fact sometimes nothing is wrong. It is helpful if you work with a talk therapist who understands varying scientific based paradigms.

Eclectic providers, like LaRose, understand basic neuro-biological structures affecting thought and feeling (what you see is in the mind, what you feel is in the body – both occur in the brain). They have a basic understanding of how hormonal shifts in between birth and senescence explain the personality changes (say, how it is that a man and a woman might shift in those seemingly gender biased reversed roles that develop in aging; eclectic providers have basic understandings of the biological equivalence once thought to only occur in psychological paradigms (meaning, one who knows what chemicals in the body activate love, attraction, lust, concentration, motivation, doubt, confidence and even happiness (did you know there are brain scans that tell us things unique to happy people, that testosterone is confidence for men and women, and that love is a trust and care hormone discovered in the human genome project around 2009?). Too your provider of care, would need to know how sleep works, what RAS means and how it plays out in cognitive views about possibilities, the impact of simple light on sleep (a little sun might help, an LED light might wake you, and OTC melatonin might be waayyy too much for any length of time at all); your clinician hopefully can talk about how weight gain and loss can be slowed just by how the gut works in normal evolutionary natural selection (enzymes that are weak and strong in a diet change could help in success and in failure).

Plus some basic knowledge of genetics as having an impact in what is already settled at birth and what is alterable in the environment, this might help you as well. For example stress responses may cause inflammation (and you may want to work with someone who uses handouts and exercises like this one to help change the stress response so that it become helpful), inflammation can lead to symptoms that are consistent with depression and anxiety and other things the eclectic pro would know. And here’s just a bit more – and certainly not everything can be covered here in one summary of PIE — sleep disturbance can be a factor of blue light, and blue light can be a factor in what looks like bipolar. Substances (not only addiction based ones, but starch and sugar too) change the brain. There may be issues of low motivation – a factor related to dopamine and activity. Adrenaline, cortisol and epinephrine, not only in trauma, but in high stress can impact the processing of logical memory in the hippo-campus affecting a reasonable and a non-reasonable ways of thinking. Relationships can be amiss, not by disorders only, but due to biological chemicals such as oxytocin and pheromones, erotic map discrepancies in sex, and simple harsh judgments of one another (such as with contempt).

OKAY, OKAY … Let’s get back to the stuff about PIE (who doesn’t like PIE, right?) ….

The point is, working with a professional who is a specialist in eclecticism, such as LaRose and other similarly trained talk therapists may be a way to sort out what is wrong, if testing is needed, if medications are needed and if the treatment plan will factor in normal biological processes that can be tweaked (or not)! LCSW’s and LICSW’s are highly trained in the broad systems at play; finding one who is not a specialist in just one area may be the best place to begin.

Here’s the PIE analogy: just as a pie is made up of many pieces, people are represented by the many aspects of life. In order to have a whole pie—every single piece is needed, otherwise all that exists are parts of a pie. Likewise, to fully understand a person, all the aspects of that person must be considered—in part and in whole.

When it comes to mental health and mental illness many variables exist that need to be considered during the assessment, diagnosis, and intervention phases. The complexities which exist in a person’s life, whether adult or child, can provide the mental health professional with ideas as to the source or cause of problems that suggest (or contraindicate) treatment. Without an interpretation of the variables, the many aspects of life, a diagnosis would likely be incomplete, or worse yet, inaccurate. The clinical picture must reflect the whole person.

For years the debate over what causes mental dysfunction has been argued—it’s called the nature/nurture debate. There is research that suggests that the environment influences human development¹³. Other research supports the impact that biological factors have on a person¹⁴. So what is the primary cause of mental illness?

Regardless of the nature/nurture argument, a comprehensive assessment by a mental health professional is critical and a good assessment considers both issues (biology and environment). Conclusions about the existence of a mental disorder should not occur based upon a 15 minute interview—it would be hard to fully inquire about the mental and emotional changes over a life span in such a short interval. How are all the variables considered when assessing a person in the context of the environment?

The things that people think, do and say, can be interpreted as “symptoms” of a mental illness. Some mental health professionals look at most issues in life as symptoms of illness, but this view does not always consider all of the pieces of the whole person.

Whether you are an adult or a child, PIE matters. The whole environment (mental, emotional, physical, spiritual, current, and past) should be viewed by an expert who understands how these complex systems operate separately and together.

Because peoples’ thoughts, actions, and feelings may be linked to their own bodies, or their families—or to the other people, places and things that surround them the PIE theory is an effective assessment perspective. To understand the whole person, every piece of that person must be interpreted—and once all of the pieces are fully understood, then the whole person can be understood. It is at that juncture, when the most accurate determination of mental illness can be made.

Be sure to ask mental health professionals if they are familiar with PIE concepts so that you can be sure that assessment and diagnosis is comprehensive—otherwise consult a Clinical Social Worker.

Rev 6/28, 8/13/19

Kurt LaRose

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