Assessment Skills for Herbalists
This is a deeper look at an assessment is deciding on what protocols work best for helping the client you are seeing in an office. This is a complex process that involves a lot of parameters but this is a general introduction to the subject with some ideas for protocols. The first thing to do is to review the assessment to see what needs to be addressed first and foremost.
Age, Gender identity, cultural background
Q: What is your full name and birthdate? Do you have a preferred pronoun? What is your background in terms of ethnicity and sexual orientation?
The very basis of an assessment is starting with asking simple questions about these areas. However, those answers can have a profound impact on the course of treatment. Someone who is old or quite young often need gentler herbs in smaller doses. IN terms of hgneder identity and cultural background, those from marginalized communities (BIPOC, LGBTQ, Neurodivergent) will also experience a far greater “allostatic load” on their nervous systems that needs to be taken into account.
Medical History
Q: Do you have any health issues or pain that is impacting you? Have you had any illnesses, surgeries or medical issues in the past that I should be aware of?
Its key to understand the health history of the client and how those ailments may impact emotional and mental health. From fibromyalgia to arthritis to high blood pressure to cancer, its key to understand what is going on for the client. The practitioner is not here to solve those larger health issues but simply to see how that history impacts current mental health. Co-morbid disorders are extremely common.
There are numerous physiological etiologies for distress and its important to address these pieces individually. While any medical malady will impact mental health, it is important to look at some of the most important issues that impact emotional wellbeing. These include-
Thyroid imbalances
Gut Health- SIBO, dysbiosis, leaky gut, poor absorption, etc
HPA- Adrenal health
Hormonal imbalances
Inflammation
Epigenetic mutations
This article can not address these myriad concerns and often its key to be working in tandem with a naturopath/functional doctor who will be best able to take blood tests and do examinations for any deeper medical maladies that are out of our purview. At the same time, there are gentle herbal protocols that can be helpful for many of these maladies. While functional doctors tend to prescribe a host of supplements, herbalists tend to focus on working with diet, teas, tinctures, broths, syrups and aromatic preparations to improve functional medicine disorders. For in depth exploration of these concerns I recommend taking Thomas Easley’s courses through his Eclectic school.
Mental Health Diagnostics
Q: Do you have a mental health diagnosis? Is that meaningful to you? How do you perceive your mental health and sense of emotional wellness?
If an individual has been diagnosed with a mental illness and that diagnosis is meaningful to them, then it can be helpful to include that in one’s assessment. Someone might say they have ADHD, PTSD or generalized anxiety disorder. But its best to dig further and get a more broad understanding of how that diagnosis shows up for an individual. Do they worry constantly? Are they hypervgilant? Do they get easily angry? Most importantly it is key to hone in on areas that are potentially severe such as self-injuring, violent and suicidal impulses. Its also key to assess for extreme states such as psychosis and mania. With complex and sometimes dangerous conditions its key to refer out to licensed therapists and providers for greater support.
Medications
Q: Are you taking medications right now and what are they? Have you taken meds extensively in your past?
For many people, medications are a life saver and truly help quality of life by increasing stability and emotional wellbeing. But while many experience relief and improvement from medications, many others are experiencing adverse side effects and withdrawal effects. Because of this it is key to ask if an individual is experiencing issues on their meds. It is possible they will need to have their med regime reevaluated by a doctor/naturopath. If you feel that the client may be overmedicated or poorly managed, it is key to suggest working with their doctor more closely to manage these issues. If they do not feel adequately supported by their doctor, it is key to offer suggestions for other doctors who are more adequately able to prescribe for them. This is not an area that we will ever tinker with in terms of offering medication suggestions, etc.
It is important to have a basic understanding of the main medication classes that people with mental health diagnoses tend to take. These include
Antidepressants (zoloft, prozac, wellbutrin)- offered for a wide spectrum of disorders such as major depression, OCD, pain management, anxiety disorders, etc. Key issues with this class of medications are emotional blunting and reduced sexual interest. This is also a class of medications tired to higher instances of suicidal ideation, especially with teenagers. Withdrawal issues can include increased anxiety, insomnia, depression and bizarre somatic experiences such as brain zaps.
Stimulants (aderall, ritalin, vyvanse) – Generally offered for ADHD and ADD but increasibnly used for chronic fatigue syndrome and binge eating disorders. Issues here include abuse of this class of meds as they are amphetamines.
Benzodiazepines (valium, ativan, xanax) Generally prescribed for short term relief of anxiety such as for panic attacks and anxiety spikes, but also commonly prescribed daily for chronic anxiety. There are huge issues with this class of medications such as tolerance/dependence, horrendous withdrawal symptoms that can persist for months and even years. Benzos also lead to increased depression and cognitive decline with long term use.
Mood stabilizers (Lithium, depakote, lamictal) These are prescribed primarily for those with bipolar disorder as a mood stabilizer. Meds like lithium and depakote require regular medical checks for potential adverse health effects.
Atypical Antipsychotics (Zyprexa, seroquel, abilify) These originally were prescribed primarily for those with severe psychotic disorders but have now become commonplace for numerous mental health disorders including anxiety, insomnia, refractory depression, OCD and panic attacks. Atypicals can cause a host of metabolic side effects such as weight gain, high blood pressure and diabetes as well as cognitive decline and flattening of mood for people who take them, especially in larger doses or as part of a polypharmacy cocktail. Withdrawal off of atypical antipsychotics can also be deeply challenging for many people with side effects of anxiety, insomnia, panic, confusion, depression and psychosis.
Z-drugs (Soma, lunesta, ambien) These are in a similar medical class to benzodiazepines and are tranquilizers prescribed primarily for insomnia. There are numerous reports of addiction issues and bizarre adverse side effects with this class of meds.
Herbally we want to avoid working with herbs that potentiate medications or interfere with their absorption and processing by the liver. In general we want to avoid
Strong nervines: Kava, cramp bark, jamaican dogwood, hops, valerian.
Herbs that interfere with metabolic processing of drugs: Saint Johns Wort, schisandra, gingko
Mixing herbs that are strongly stimulating with stimulant drugs and sometimes antidepressants: Coffee, tea, ephedra, asian ginseng, rhodiola
Besides contraindications, the main thing that herbalists often explore is how to support an individual who is working through withdrawal effects from the medications themselves or from the challenges of helping someone who has tapered off completely and still is managing post acute withdrawal symptoms (PAWS).
In general the approach should be gentle and focus on healthy nourishment, gentle nervine and tonic herb supports. The second is that meds tend to have a deleterious effect on the gut, and especially the psychiatric meds with antidepressants, benzodiazepines and antipsychotics topping the list. That means it is important to suggest helping the individual to retire gut health if they have tapered down or off medications. A very gentle diet filled with soups, broths and well cooked veg and meat is key here. Again emphasis is on gentle! Bone broth (see below) is instrumental in restoring health and I would add herbal teas that are filled with gentle aromatic nervines that improve digestive function (see the tea section).
Trauma History/Sensitivities
Q: You don’t need to tell me details, but I am wondering if trauma has impacted your life strongly and at what age that trauma happened?”
Many people with significant history of trauma are sensitive to small triggers and are more sensitive to tinctures and preparations that strongly shift mood. The feeling of being altered can elicit feelings of vulnerability. Because of that it is essential to go slow and gentle with this population. There should be caution around the use of strong nervines and strong plants in general.
Stressors in life
Q: What is stressing you out these days?
The practitioner will always hone in on the underlying roots of distress of the client and this often has to do with relational, workplace, family and monetary stresses. If there are areas where the client can shift to reduce stressors, it is always key to explore that first. I once did a complete workup with an herbalist who was about to offer me some herbal protocols- but then he asked about my work (previous very stressful job). I told him and he said forget all of what he would suggest- and that it would be hard to get better without quitting or radically changing my job.
Diet
Q: What is your typical diet look like on a daily basis?
Yes there are myriad diet types that can be quite helpful for people to get better- including variations on Paleo, Autoimmune paleo, GAPS, SCD, etc. As a practitioner I do not focus on these restrictive ideas for a few reasons. It is exceedingly hard for most people to radically change their diets but most people can make some changes. This is why I aim for the “low hanging fruit”. That means examining how much an individual is consuming sugars, simple carbs, processed foods, fast food, soda as well as caffeinated beverages. Reducing or eliminating these foods/drinks is at the core of helping people heal. After that a select group may do better avoiding gluten and dairy products.
I also strongly emphasize a Weston Price model of eating that emphasizes lots of healthy fats, broth, soups, nutrient dense vegetables and grass fed organic meat and eggs. Sally Fallon has written two amazing books – “Nourishing Broth” and “Nourishing Traditions” that are at the core of how I work with diet if someone wants to go there. What I see mostly in my practice are people who have significant digestive problems due to diet, lifestyle, previous trauma, medications and stressors. Because of this I emphasize eating foods that are gentle and nutrient dense. Instead of elimination diets, I emphasize adding foods and herbs that are healing to the gut. I have written the article Trauma, the Gut and Healing: Building Deep Resiliency to explore that more deeply.
So outside of addressing the low hanging fruit of reducing or eliminating challenging foods, I recommend adding in teas and broths that help heal the gut. A gentle nervine tea that is also aromatic and slightly bitter can really help an ailing gut. Broth that is filled with herbs that include aromatics, bitters, tonics and nutrient rich herbs is often key for people who have experienced severe stressors that have impacted their health long term.
Sleep
Q: How much do you sleep on average? Do you have a hard time getting to sleep or wake up in the middle of the night? For how long are you awake when you wake in the middle of the night?
As a modern society, sleep has become increasingly secondary to work, playtime, screens and staying up late partying. That has a cumulative effect on the nervous system and makes us less resilient to stressors and triggers.
Employment
Q: Are you working right now? Do you like your job, your co-workers and your boss? If you could change one thing about it what would that be?
We spend the bulk of our lives engaged in employment. Our relationships with our co-workers and our satisfaction with our job translates directly into whether we feel depressed, anxious and generally happy or not.
Relationships
Q: If you are in a relationship, how long have you been with your partner? Do you feel happy and loved in your partnership? Do you feel like you have a healthy loving relationship or are there blocks that are frustrating you? Do you get to spend quality time with your partner? How do you feel about the quality of your connection to the other main people in your life- parents, kids, friends?
Our relationships with our loved ones forms the core sense of emotional resiliency and safety in our lives. It is often the main thing that therapists explore with their clients.
Alcohol/Drug Use
Q: How often do you consume alcohol, cannabis and other drugs and in what quantity? Do you feel in good relationship to your usage or that you are using too much?
You will see individuals who commonly come in with addiction and overuse issues to different substances. This requires a variety of approaches. The main issue is determining if the individual is ready to make significant changes here. If so, it is also key to determine if the individual will want to move towards full sobriety or simply wants to reduce harm by reducing usage or switching to less harmful substances. There are a variety of treatment options for either that we won’t get into here. But what is important is supporting an individual while they are trying to overcome addiction. A variety of herbal protocols are possible here and generally the protocol is similar to working with anyone dealing with chronic long term health issues and medication withdrawal. There can be an emphasis on helping restore and heal liver function through the use of milk thistle, dandelion root, burdock root, small amounts of licorice and angelica.
Activity
Q: How often do you exercise or move your body during the day? Does it feel like the right kind of exercise for you and do you feel like you are doing enough or too much?
Movement and exercise are key to a healthy nervous sysetm. Too little will lead to feelings of stagnation and sometimes weight gain and feelings of being heavy and uncomfortable physically. On the flip side, too much aerobic exercise can sometimes burn people out and leave them feeling fried, depleted and exhausted.
Self-care
Q: Do you set aside time in your life for self-care? Some examples of this include going to watch movies, exercising, yoga, gardening, baths, massages, acupuncture, dates with friends?
This is sort of an overused concept and can appear classist to people who have to struggle to work multiple jobs, tend to their kids and have little time for self-care. At the same time, self-care is essential to a healthy nervous system.
Relationships
Q: If you are in a relationship, how long have you been with your partner? Do you feel happy and loved in your partnership? Do you feel like you have a healthy loving relationship or are there blocks that are frustrating you? Do you get to spend quality time with your partner? How do you feel about the quality of your connection to the other main people in your life- parents, kids, friends?
Our relationships with our loved ones forms the core sense of emotional resiliency and safety in our lives. It is often the main thing that therapists explore with their clients.
Energetics
In many cultures, one examines an individual according to their constitution and in terms of any energetic imbalances. In the Western tradition this has been based on the four elements as seen below. You can delve into this more via this article here- Traditional European Medicine. Generally a practitioner would determine the persons constitutional imbalances via listening to the client, his voice timber, looking at his skin pallor, his tongue and assessing the pulse.
For a beginning practitioner we can be a little more simple about it. Look for the main signs on an individual:
Hot
lemon, lycium, peach bark and bilberry.
Cold
capsicum, ginger, rosemary, horseradish and thyme.
Moist
burdock, echinacea, red clover and yellow dock.
Dry
cordyceps, Korean ginseng, American ginseng, slippery elm, marshmallow and licorice.
Tension
kava kava, lavender
when tissues are unable to hold fluids due to damage or loss of muscle tone. Examples of this include diarrhea, leaky gut, excessive mucus production, bleeding, urinary incontinence and excessive sweating.
Herbs containing tannins are used to tighten tissues and stop excessive drainage. These herbs are called astringents and have a slightly bitter and drying taste. We refer to remedies with this property as constricting. Examples of astringent herbs include white oak bark, uva ursi, yarrow and bayberry.
Compliance
This is probably the most important thing to examine as one can come up with a thousand amazing interventions butt they are pointless if the client never partakes. Finding the right way to help an individual that they will actually engage with is likely the hardest part of working own this area.
Further Reading:
Read: The Roots of Distress
AHG: Herbalism in Context: Interpreting a Client Interview and Shaping an Outcome
Ethics: Herbalist’s Guidelines for Avoiding the Practice of Medicine
Introduction to Tongue Assessment for the Western Herbalist
Questionnaire
Age, Gender identity, cultural background
Q: What is your full name and birthdate? Do you have a preferred pronoun? What is your background in terms of ethnicity and sexual orientation?
Medical History
Q: Do you have any health issues or pain that is impacting you? Have you had any illnesses, surgeries or medical issues in the past that I should be aware of?
Mental Health Diagnostics
Q: Do you have a mental health diagnosis? Is that meaningful to you? How do you perceive your mental health and sense of emotional wellness?
Medications
Q: Are you taking medications right now and what are they? Have you taken meds extensively in your past?
Trauma History/Sensitivities
Q: You don’t need to tell me details, but I am wondering if trauma has impacted your life strongly and at what age that trauma happened?
Alcohol/Drug Use
Q: How often do you consume alcohol, cannabis and other drugs and in what quantity? Do you feel in good relationship to your usage or that you are using too much?
Stressors in life
Q: What is stressing you out these days?
Diet
Q: What is your typical diet look like on a daily basis?
Sleep
Q: How much do you sleep on average? Do you have a hard time getting to sleep or wake up in the middle of the night? For how long are you awake when you wake in the middle of the night?
Activity
Q: How often do you exercise or move your body during the day? Does it feel like the right kind of exercise for you and do you feel like you are doing enough or too much?
Self-care
Q: Do you set aside time in your life for self-care? Some examples of this include going to watch movies, exercising, yoga, gardening, baths, massages, acupuncture, dates with friends?
Employment
Q: Are you working right now? Do you like your job, your co-workers and your boss? If you could change one thing about it what would that be?
Relationships
Q: If you are in a relationship, how long have you been with your partner? Do you feel happy and loved in your partnership? Do you feel like you have a healthy loving relationship or are there blocks that are frustrating you? Do you get to spend quality time with your partner? How do you feel about the quality of your connection to the other main people in your life- parents, kids, friends?
This article written by Jon Keyes, Licensed Professional Counselor and herbalist. For more articles like this, please go to www.Hearthsidehealing.com. You can also find me at the Facebook group Herbs for Mental Health.
