burgeoning success of integrated care brings with it a complicated
by-product. The diverse range of behavioral and mental health
professionals are stepping up to the plate. Many of these
professionals, trained under the "old guard” as competitors in the
market, are now tasked to re-align in the context of a new paradigm. The
following represents insights from a year-long conversation (tongue in cheek) between two friends and colleagues, one a clinical psychologist
and the other a medical family therapist who are in search of a model of
intra-disciplinary collaboration. Dr. Jodi Polaha, Most Awesome Clinical Psychologist (and humble too):
Last fall, I sat through an uncomfortable board meeting. I was charged to
work with a Clinical Social Worker, Licensed Practicing Counselor, a
Counseling Psychologist, and a Licensed Nurse Practitioner to develop an
integrated care training program as part of a rural workforce
development project. Whose students could provide treatments in
behavioral medicine? Whose students could help develop programming?
Whose students understood research well enough to do program
evaluation? "Ours!” I said, smiling.
So did the other professionals in the room.
I shouted in my mind. I tried to keep my facial expressions in check,
but it was hard. Everyone knows social workers help people get food
stamps and find support groups, right? Everyone knows our counseling
friends deal mostly with life-adjustment issues, right? And everyone
knows that clinical psychologists are superheroes, trained in the
scientist-practitioner model, who REALLY CAN do everything…RIGHT?
was challenged by this conversation, and recognized my long-held,
inaccurate stereotypes of other mental health disciplines, including my
own. Still, some questions made me itch: Can mental health
professionals from various training backgrounds work harmoniously in
integrated care? If so, could their roles be interchangeable? Should
I took my questions to Dr. Jennifer Hodgson. Who would know better
than the president of CFHA? Granted, she is a marriage and family
therapist (or medical family therapist as she calls herself these days),
so she lacks the finely-honed analytical skills of a clinical
psychologist. She can pick out a cute suit, though, so I felt it was
worth a try.Dr. Jennifer Hodgson, Supreme Marriage and Family Therapist:
I would like to say, when Jodi Polaha approached me with questions
about intra-disciplinary collaboration, I had to hide my confusion. Why
would a clinical psychologist be concerned about this? Don’t they mainly
do testing and inpatient work with serious and persistent mental
illness? Isn’t their training mainly in one specific area of health or
mental health? What are they doing in primary care? I would not want a
foot specialist operating on my eye, after all! How does she figure she
is a team player with the likes of medical family therapy, who, we all
know, leads the field in advancing integrated care! I know what is
going to happen, she just wants psychologists to take over the
leadership of this integrated care movement. Arguably, they do have
Medicare in their back pockets, but so do social workers. Does that mean
though that they are better integrated care clinicians?
are so many inaccuracies in how different mental health disciplines are
trained that perpetuate the ideas that others are less well trained
simply because of their degree. Why can’t a social worker, pastoral
counselor, professional counselor, or family therapist (had to get my
field in there somehow) run an integrated care service with a blend of
professions present? Of course we can work harmoniously Jodi, but we
first have to be willing to be vulnerable and willing to learn from one
another in the field.
have gotten to a place where I just want all mental health disciplines
to stop figuring out who is best based on degree and to start taking
classes together, training in the field together, and promoting policy
for parity together. We would be even better together…if only we knew
how to share the space. It is the old adage of those who have power want
to hang on to it and those who want it are working hard to get it. I
tell my students that there is plenty of room in the sandbox so no need
to throw sand to create space.
healthcare professionals just want someone who can do the job and
cannot understand why some mental health providers cannot work together
easily. I go back to how people were trained, Jodi, and I believe
strongly that we can be retrained to learn models of integration that
embrace multiple disciplines in the same location. We can share the
work, divide the responsibilities, and promote one another’s strengths.
We can embrace hiring someone not because of the degree, but because he
or she meets the patient population’s needs and has the core
competencies (to be determined) to provide integrated care services.
starts at the training level and I believe CFHA is the place where we
can drop our labels and learn the core competencies needed for the work.
I know my calling is to train the next generation to behave
differently, but it starts with me and sometimes I struggle with it too.
I want to understand why we cannot just drop the entitlements...but as a
systems thinker I know that change happens slowly, thoughtfully, and
organically (with a smidge of encouragement from associations like
CFHA). Dr. Jodi Polaha
funny, in spite of my reaction to that board meeting last year, this
year in Philadelphia, I had so many positive interactions with
professionals from so many varied disciplines. In that forward-thinking
environment, Jennifer, it was truly effortless to meet the spirit of
your ambition for all of us. I learned from social workers, public
policy people, and physicians. I exchanged cards with a school
psychologist from Florida, with similar research interests to my own.
The energy in this mixed group was incredibly engaging and specific
credentials, training history, and even experience seemed to fade away.
In another week, I am off to a clinical psychology conference and,
reflecting back, I feel I was more among "my people” at CFHA than I will
occurs to me that the mental health professionals involved in
integrated care have so deftly cast off the old guard notions about the
50-minute session, the cozy psychotherapy room, and even the term
"mental health.” I’d like to see your vision become a reality,
Jennifer. Perhaps, the stereotypes and competitive dispositions will be
the next to go.
PhD, is a licensed Marriage and Family Therapist, Associate Professor
in the Departments of Child Development and Family Relations and Family
Medicine at East Carolina University, and outgoing President of CFHA. She has
over 18 years clinical experience and has served on numerous boards and
committees related to healthcare and mental health care issues. She is
co-author to the first doctoral program in medical family therapy in the
|Jodi Polaha, Ph.D. is an Associate Professor in the Department of Psychology at East Tennessee State University where her primary professional interest is research, training, and workforce development in rural integrated practice. In addition to her work, she spends lots of time with her husband and two young boys swimming, biking, and hiking in the surrounding mountains.|
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