Posted By Tom Bishop,
Thursday, May 09, 2013
| Comments (1)
Tom's post is the 2nd installment in this series. You can read the first post here.
I certainly appreciate Dr.
Reitz’s assertions of a developmental progression in professional identity
formation as one prepares to work within integrated care. It does seem intuitive that one would pass
through each of Chickering’s seven "vectors” as they progress through training
and service as a primary care provider.
It is also seems plausible, and very much supported by observances in
the field, that there is a personality style, or as Dr. Reitz
postulates, a "collaborative identity” that tends to lend oneself in being a
good "fit” for serving within integrated care.
That said, I believe that taking
another pass at McDaniels et al (2002) curricular article may provide more
clarity to why some clinicians excel at integrated care and embrace innovation
over traditional roles. McDaniels comments, "Psychologists-in-training need to
develop the skills that solidify their identity as psychologists” and that
having a "positive professional identity” would serve one well in working
within primary care.
I am led to recall an experience
I had with a couple of students in training.
They were sharing the tension they experienced in learning the core
skills and attributes of what it means to be a psychologist while considering
what their work would look like within a primary care setting. They voiced concern that working in an
integrated care setting, especially at that start of the training, would be too
"narrow,” and limit the development of their clinical skills in some way. I believe that these concerns are closely
tied to how one understands what it means to be a "psychologist.”
|More recently, the field of
psychology has begun gravitating back toward a more comprehensive identity. I
say "gravitating back” because Lightner Witmer who is considered by many to be
the father of modern clinical psychology understood psychology as
collaborative, scientific, and as a catalyst for addressing problems. According to one reference: "Witmer never
intended for clinical psychology to become segregated from other helping
professions, particularly medicine and school psychology” (Brown, Prime, &
Wade, 2012, pg. 1). However, this vision
for the field has not been the prevailing image or impetus of training. "Indeed,
Witmer envisioned a unified yet multifaceted discipline that possessed many
progressive and innovative ideas that were lost or ignored over the course of
the 20th century” |
(See pg 2 where Brown et al discuss Routh, 1996).
|One reason clinicians |
may flounder within integrated
care is that they have come to
embrace a more "contained” perception of what it means to
be a clinical
medical family therapist, social worker, or school psychologist.
Put broadly, then, one reason some clinicians flounder within integrated care is that they have come to
embrace a more "contained” perception of what it means to be a clinical
psychologist, medical family therapist, social worker, or school psychologist,
and that perception is inherently independent rather than collaborative.As a corrective, training
programs might emphasize the importance of core, foundational skills that would
allow a behavioral clinician to collaborate with others rather than become
"soloist.” It may also be critical to
stress that our training allows us to be good at what we do, and that we are
not to become something that we are not.
Elliott and Klapow (1997) suggested that "We must broaden the
professional options for our trainees by emphasizing behavioral science
expertise versus mental health service provision.”
In returning to Dr. Reitz’s
discussion of Chickering’s model as providing a means of examining professional
identity formation, there is at least one other consideration. Perhaps training and early career experiences
are more characteristic of what Erikson and James Marcia described as a time of
crisis in one’s sense of occupational and social identity. This period of professional life is fraught
with the search of "fit,” growth, conflict, and tension.
While personality is a factor,
early career clinicians identification with their profession may be more characteristic
in how they have wrestled with what it means to be functioning as a behavioral
clinician. Some may have entered into
training and work with a great deal of uncertainty and little reflection or
consideration (Identity Diffusion), while others may have gone in full throttle
with little exploration of what their particular field (e.g., psychology,
social work, etc.) could encompass (Identity Foreclosure). Still others may truly be in crisis where
they are unsettled and desire more from the work that they are doing, which
seems to fit Dr. Reitz reflections on establishing identity (Identity
Perhaps "controlled and supported
crisis” is what may be helpful in training and in challenging trainees to
consider a broader conception of their discipline. It may be that McDaniel and the other authors
were speaking of Identity Achievement when they commented how having a solid
identity would prepare one for working within integrated care. They would possess the core understanding, skill
set, and commitment for what it means to be a psychologist.
- The success of a clinician in integrated care
is inherently linked to how we portray, teach, and model a comprehensive
understanding of what it means to be a particular behavioral health discipline,
whether that is a psychologist, social worker, medical family therapist, or any
other. Trainers want to foster the development of a
sound identity for that discipline.
the same time, trainers could do better at challenging trainees in developing
broader skills and in challenging their notions of what it means to be a
psychologist, social worker, etc. It
seems that this would be facilitated by having training opportunities that are
more inter-professional and collaborative.
These opportunities would, perhaps, create conflict and crisis in roles
and functioning within an interdisciplinary team.
personality is certainly a factor in what leads one to consider a career in
integrated care, this could be said of any profession, ie…why does one person become
a plumber vs an engineer? Perhaps an
analogy would be the contrasts of a jazz musician who is classically trained
and a musician of another genre of music – they are each well versed in the
foundations of their craft, but express these skills in varying ways.
I am certain and hopeful that the
next response will challenge many of these premises.
Dr. Bishop joined the faculty at the Johnson City Family
Medicine Residency program at ETSU/Quillen Medical School in March of last year
after serving several years with Cherokee Health Systems as a Behavioral Health
Consultant and pediatric primary care psychologist. Thomas received his Psy.D. in Clinical
Psychology from Wheaton College with an emphasis in the integration of
psychology and theology, and a Masters degree from Central Michigan in general
experimental psychology with an emphasis in brain injury and recovery of
function. His professional and
research interest include primary care, rural and organizational health, faith
and medicine, positive psychology in medical care, sports psychology, and
neuropsychology. Perhaps most
important, he and his wife Barb, who is brilliant in math, and have three
children, two in college and one that thinks she should already be in
college. They are often found together
on a trail, running, or camping.
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