A List of Things Worth Memorizing (for clinicians)

Disclaimer:  nothing in this post should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care. 

Around 25 years ago the topic of a “list of things worth memorizing” was presented by a trainer who came to our agency.  The trainer suggested a list of things worth memorizing could be helpful for clinicians, clinical supervisors, and program managers.  The trainer said that each person should determine what should be on their own list. 

The idea was that if a clinician actually memorized things, then those things would be available in real time.  How simple.  The idea struck all of us as attendees as basic, and helpful, and wonderful.   

The trainer challenged us in this way:  “What would be helpful to have memorized, rather than needing to look it up later?”  The trainer told us that things we memorize could serve in any number of ways, including as a:

• Lens through which to listen (data);
• Resource to help understand the person served (assessment);
• Framework to consider while developing or providing clinical interventions (plan).

The trainer pointed out that something that’s memorized can be useful, and brought up consciously in the mind of the clinician like a heads-up display.  It can serve as a template for the situation to which it applies.  We were told the only real trick is to actually memorize whatever you say is worth putting on your list, and then to later remember you have the list in the first place. 

But during this training the major focus was on how to determine what to put on such a list.  And that we should modify our lists over time. 

The impact of this topic as a question to carry has been very significant for me, and I’ve been meditating on the idea of such a list for about 25 years. 

• Pushing myself to try to recognize what is necessary and sufficient to memorize has been a helpful mental project causing me to pay attention. 
• As I’ve learned new things over the years, I’ve considered, “Does this go on the list?” 
• And I’ve taught the idea of such a list to generations of clinical supervisees of counseling, and of those I’ve trained and mentored in clinical supervision.

The trainer did suggest a few basic considerations for what we could include on our individual lists:

• The DSM diagnostic criteria for the most common one or two primary diagnoses in our particular setting or service area.
• The DSM diagnostic criteria, or similar standardized list of identifiers, of the few most common co-occurring disorders in our particular settings or service areas.
• Stuff that’s helpful for developing clinical techniques during service delivery.

What’s on my personal list at this point?  Here’s the majority of my current list.

• Medical mimics of mental disorders
• 4 steps in pharmacokinetics
• Depressive episode
• Manic episode
• 5 principles of motivational interviewing
• MET/FRAMES
• Assessment of strengths
• Clusters of personality disorders
• The 11 DSM SUD criteria
• The Big 5 SUD criteria

To make the trainer’s idea most useful I also have the list of what’s on the list memorized – like a meta-list.  Over the years, from time to time, I add something to the list. 

Below I’ll provide what I’ve memorized for each one and give some commentary or a situational example to help make it clear.  For some items I’m able to provide a resource or citation of the content.

Medical mimics of mental disorders: THINCMED (Hedaya, 1996).

• Tumor
• Hormone
• Infection/Immune suppression
• Nutrition
• Central nervous system integrity
• Miscellaneous
• Environmental toxin exposure/Electrolyte imbalance
• Drugs: prescription, over the counter, street.

I’ll never forget a patient on my caseload back in the mid 1990’s who had a ten year history of unremitting depression – along with CBT for depression and ten years of world-class psychopharmacology interventions.  All of that assistance was only marginally helpful.  Then, not long after that patient was admitted to our long-term residential program, our program’s medical director read that history and simply wrote an order for a certain lab test.  When the result came back with abnormally low findings our physician then wrote an order for hormone replacement therapy.  Her depression remitted in less than two weeks and never returned. 

Later, when I read this list of medical mimics of mental disorders, I remembered that person’s story and I knew I was adding this to my list of things worth memorizing.  For me, that list of medical mimics has been super helpful. 

I’ll never forget when I undertook some focused learning in the early 2000’s related to psychopharmacology and the basics of drug metabolism.  This included drug-drug and drug-food interactions.  From that point on I’ve used “Can you eat graham crackers?  Should you eat graham crackers?” as my cartoon-like, easy-to-remember placeholder for appreciating this entire domain of knowledge.  Afterall, to the body, food is a chemical.  It’s been helpful for me to know things can go wrong in various ways, differently, at each of these 4 stages in the process.  The main way it’s been helpful to me is to help me improve my “alert ignorance” – the clear realizing of what it is that I don’t know – and then go ask or discuss with a nurse, PA, NP, or physician.

Depressive episode:  SIGECAPSS

• Sadness (excessive)

• Interest (low)

• Guilt (excessive)

• Energy – low (atypical high)

• Concentration (poor)

• Anhedonia

• Psychomotor retardation (atypical agitation)

• Suicidality

• Sleep – increased (atypical decreased)

Clinical depression is so common in the severe and chronic SUD population that this list has been immensely useful for me on a regular basis.  The wisdom of our trainer that the diagnostic criteria for the co-occurring disorder with the highest rate of frequency in your setting or service is probably worth memorizing turned out to be true.  Experiencing that truth myself somehow made its validity more real.  I learned this during the DSM-IV era. 

Manic episode:  DIGSHAFT

• Distractibility

• Irritability

• Grandiosity

• Sleep (reduced)

• High risk behavior

• Agitation

• Flight of ideas

• Talkative

Before we left the training that day, a couple of the clinical psychologists in our agency said that the criteria for a depressive episode and for a manic episode were worth putting on the list.  They worked in the MH side of our agency.  I liked their idea but I didn’t know if it was a real fit and really worth it for me – someone who worked in a long term residential SUD program, and a methadone maintenance outpatient program. 

To help myself decide, I looked at the epidemiology literature and clinical depression was easily in first place among co-occurring MH conditions for people with severe, chronic, and complex SUDs.  I went ahead and memorized the criteria for a manic episode too. 

That list for a manic episode has been more useful more often than the list for a depressive episode.  Why?  By using these two lists of criteria I’ve learned over time that depression tends to be easier to identify, while mania on any level is harder to do the differential diagnosis with – given the range of substance classes with addiction potential we often encounter (especially stimulants).  I also learned this one during the DSM-IV era. 

5 principles of Motivational Interviewing:  E, D, A, R, S

• Express empathy

• Develop discrepancy

• Avoid arguments

• Roll with resistance

• Support self-efficacy

I remember that in the mid to late 90’s we were getting intentionally-provided training on MI.  It was a whole different way to think and to provide therapy.  I’ll never forget a staff meeting we had in the late 90’s when a patient about 2/3 of the way through the long-term residential program had been discussing the possibility of going home on pass.  The patient was not present at the team meeting.  Our team discussed the pros and cons of going, and of not going.  It became a very drawn-out discussion leading to a certain kind of pointed impasse among the staff.  I didn’t like where the discussion was leading, as it seemed to be a topic with no natural resolution, and would produce division if the discussion kept on going.  But regardless, the staff were getting stumped.  Should we let the patient go on the pass or not?  Feeling hopeless, I regressed into my own mind looking for answers.  I remembered “The 5 Principles of Motivational Interviewing” from my list of things worth memorizing. 

“Express empathy”, I said to myself.  Not a fit.  “Develop discrepancy”.  Not a fit.  “Avoid arguments”.  We were arguing as a clinical staff and the patient wasn’t even in the room.  “Roll with resistance”.  That didn’t fit, if only because the patient hadn’t even submitted a pass request.  “Support self-efficacy”.  BINGO! 

I told the staff we should bring the patient in, mention the pass as an opportunity, and have them figure out if they wanted to request it or not, and we would support either decision.  The staff was greatly relieved and the patient was boosted by this kind of validation of their autonomy.  What a lesson for us.  It seemed we needed the principle more than the patient did. 

I’m old fashioned within various formats and portions of MI and personally prefer the EDARS format to anything newer from MI.

FRAMES (Motivational Enhancement Therapy)

• Feedback

• Responsibility

• Advice

• Menu of options

• Empathy

• Self-efficacy

During the BHRM project (1997-2007 or so) we chased fidelity to MI across our agency, with great gusto and sustained intent, using best-practice supervisory techniques for a number of years.  We eventually made a formal decision to give up on MI as being too aspirational and not practical enough for the clinical staff, given our mainly very severely disturbed population of patients with profound symptoms of mental disorders, substance use disorders, and co-occurring disorders.  As a leadership team we made the decision to replace our emphasis on MI with an emphasis on MET/FRAMES.  It had more clinician-ready accessibility, and patient-ready relevance.  We didn’t abandon MI entirely. 

By having both the 5 principles of MI and the FRAMES strategies from MET memorized, I have come to appreciate the ability to choose or oscillate between the two in-the-moment, as the current situation presents itself. 

Assessment of strengths:  ROPES (Graybeal, 2001)

• Resources

• Opportunities

• Possibilities

• Exceptions

• Solutions

During the BHRM project Thomas Murphy and I were made co-chairs of an ad-hoc working group tasked with finding the best practice literature on strengths.  The strengths-model was already in our field and its literature; the question was not one of how to do strengths-based counseling but rather of assessment of strengths themselves in a simple form.  We found the “ROPES” model.  In short, having this format memorized has been super useful, as I’m sure you can imagine. 

For the person not familiar with the ROPES model, I’ll say one thing. “Exception” means something like “…when the problem doesn’t happen.” This points the clinician towards periods of wellbeing, effective self-care, or exploring what is happening when the problem is not happening or manifest. As a behaviorist, that made tons of sense to me and helped me not just chase down sources of variability but also get a specific picture of strengths related to those periods of time.

Personality Clusters: A, B, C  (DSM)

• A (odd, eccentric): SPS
  • Schizoid
  • Paranoid
  • Schizotypal
• B (dramatic, emotional, erratic): BAHN
  • Borderline
  • Antisocial
  • Histrionic
  • Narcissistic
• C (fearful, avoidant): DOA
  • Dependent
  • Obsessive compulsive
  • Avoidant

As a working clinician, my main personal benefit of memorizing this list and framework has been two-fold.  One is a concurrent awareness of the 3 clusters as described by the words in parentheses.  That is to say, when considering personality, I often start by mentally scanning the 3 clusters.  I do this by recalling the descriptive words for each cluster to see if a relevant place to land my thinking is present. 

Beyond the simplicity of the 3 clusters, also having the individual disorders memorized means I can consider the disorders on the fly individually or concurrently. 

Further, imagine laying the entire list of disorders sideways and considering them as individual features or factors – like channels on a sound board for concert mixing or a multi-band EQ for a stereo.  This has allowed me to pick up traits, styles, and various nuances – at least as a starting place – from which to consider the giant domain of personality.  That is, because of memorizing the disorders within the clusters, I can handle them as concurrent categories of function that might or might not be individually present.

I’ve added this list on the topic of personality within the most recent 15 years or so, and it’s been super helpful for me.

The 11 DSM-5 criteria for SUD.

When the DSM-5 came out we had a lot to do in terms of new memorizing.  While memorizing this material, it helps to work with the list in any order, and in both directions.    

• For example:  “Criteria 6 – can you recite it.”
• Or:  “Use in physically hazardous situations.  Which Criteria number is that?” 

If you have this list worked in your memory in such a way that you know the material in any order and in both directions (the number for each criteria, and the criteria for each number), it might improve your listening with patients and functioning with team members.

“The Big 5 SUD Criteria” (Hoffmann)

• 2, 4, 5, 7, 11.

The significance to me of this area of Norm Hoffmann’s work is very high.  I’ve written about it elsewhere. 

The break-down of the Big 5 SUD criteria, the 2 lightest criteria, and the remaining criteria (with intermediate weight) is the latest addition to my list.

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What’s on your list of things worth memorizing? 

Or, if you don’t have one at this point, what do you think you would put on your list?

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References and Suggested Reading

Cozza, K., Armstrong, S. C., Oesterheld, J. R. & Cole, M. A.  (2001).  Concise guide to the cytochrome P450 system:  Drug interaction guidelines for medical practice.  American Psychiatric Association, Inc.

Graybeal, C. (2001). Strengths-Based Social Work Assessment: Transforming the Dominant Paradigm. Families in Society, 82(3), 233-242. 

Hedaya, R. J. (1996). Understanding biological psychiatry. W W Norton & Co.

Kopak, A. M. & Hoffmann, N.G. (2024). Key criteria within DSM-5 substance use disorder diagnoses: evidence from a correctional sample, Journal of Offender Rehabilitation, 63:1, 37-57.

Kopak, A.M., Hoffmann, N.G. & Proctor, S.L. (2015). Comparison of the DSM-5 and ICD-10 Cocaine Use Disorder Diagnostic Criteria. Int J Ment Health Addiction, 13, 597–602.

Kopak A.M., Proctor S.L., Hoffmann N.G. (2012). An assessment of the compatibility of DSM-IV and proposed DSM-5 criteria in the diagnosis of cannabis use disorders. Subst Use Misuse. 47(12): 1328-38.

Kopak, A.M., Proctor, S.L. & Hoffmann, N.G. (2014). The Elimination of Abuse and Dependence in DSM-5 Substance Use Disorders: What Does This Mean for Treatment? Curr Addict Rep 1, 166–171.

Malone, M & Hoffmann, N. (2016). A Comparison of DSM-IV Versus DSM-5 Substance Use Disorder Diagnoses in Adolescent Populations, Journal of Child & Adolescent Substanc Abuse, 25:5, 399-408.

Proctor, S. L., Kopak, A. M., & Hoffmann, N. G. (2014). Cocaine use disorder prevalence: From current DSM-IV to proposed DSM-5 diagnostic criteria with both a two and three severity level classification system. Psychology of Addictive Behaviors, 28(2)