Posted By Jeffrey Ellison,
Thursday, May 16, 2013
| Comments (2)
Jeff's post is the 3rd installment in this series. Click here to read the first and second posts.
comments of Dr. Reitz and Dr. Bishop in this series to date bring to mind a
recent conversation with several of my fellow graduate students. In this conversation, my peers suggested
that: 1) integrated practice is less complex and thus less effective than
traditional methods of clinical practice, and 2) mental health providers with sub-doctoral
training are qualified to provide collaborative care services, so why would a psychologist
want/need to do it?
I first began writing this post, I had planned to formally rebut my peers’
"misconceptions” of integrated primary care (Had they actually read the
research?); to finally set-the-record-straight about integrated primary care (What
about psychotherapy? There are plenty of very qualified and competent
sub-doctoral level providers with expertise in traditional psychotherapies!); and
to prove to everyone that the practice of integrated primary care is actually a
worthwhile endeavor (Even for a psychologist!).
As I read through the other blog contributors’ posts, however, I began
to sense that the conversation that I had with my peers was not about the
"facts” of integrated care at all.
Instead, this conversation may have been a representation of our
divergent professional identities.
how do students 3, 4, or 5 years into their respective programs develop such
different professional identities? In
the initial post in this series, Dr. Reitz discussed how trainees pass through Chickering’s
seven "vectors” multiple times throughout their educational journeys. In the first years of graduate training, the
"identity” that all trainees develop (Chickering’s 4th vector),
though broad and rudimentary, is likely fairly uniform across trainees. As trainees undertake more clinical
experiences they pass through Chickering’s vectors again and again (e.g., during
beginning practicum, advanced practicum, and internship, etc.). || Trainees are particularly
vulnerable to identifying
with the first thing
(i.e. model, theory, etc.)
which they become
confident and competent.
Through this process, students hone and focus
their professional identities based on many factors including personalities,
interests, and specific experiences. Inevitably,
as a result of this process, students will conclude their training with unique
and personally tailored professional identities. Increased job satisfaction, career
investment, and productivity are all likely positive side-effects of this
process. Additionally, this process
promotes variety within our respective fields, thus allowing our fields to
remain flexible and adaptive even in this ever-evolving healthcare
there are also downsides to our increasingly divergent professional identities. In the conversation I described above,
neither my peers nor I were able or willing to stray from our narrowly defined
professional identities. We took the
same classes, participated in the same clinical experiences, worked with the
same supervisors, and progressed though the same clinical psychology program, but
we seemed to have nothing in common! How
could this be? In reading again through
the previous posts, I realized that the reason that it may have seemed that we
had nothing in common was that, though we had well developed individual professional identities, we
had poorly developed group
professional identities (e.g., we had only vaguely and narrowly defined
concepts regarding what it really to be a clinical psychologist or mental
health provider). In other words, we had
become so focused on "the trees” that we could not see "the forest.”
recognize this as a problem specifically within the clinical psychology training
process, however, I would bet that the same problem occurs within other fields
as well. I hypothesize that this
hyper-focus on specialization (i.e., sole focus on developing an individual professional
identity) has its roots in the first years of training. When trainees enter graduate school, they
typically come from a undergraduate programs where they were likely considered
highly competent and top-of-the-class.
When they enter graduate school, however, they are again inexperienced
"newbies,” who have to prove themselves in a new program. Because of this, trainees are particularly
vulnerable to identifying with the first thing (i.e., model, theory, etc.) with
which they become confident and competent.
Students become fixed on domains in which they are competent instead of
continuing to explore new things (i.e., models, theories, etc.) and struggling
with incompetence again. Granted not all trainees are seduced in this way, but
in my case, it certainly makes sense. My
initial practicum experiences occurred in integrated primary care, a setting
where I am still exclusively practicing today.
In writing this, I am
not trying to suggest that it is not okay to specialize or that it is a necessarily
a mistake to become enamored with the first experiences in which you taste
confidence and competence.I am
suggesting, however, that it is important for trainees to carefully analyze
their motivations.I also think that it
may be important to rethink the structure of training programs so that they may
have introductory experiences (i.e. not just book work) in a wide range of
clinical models and theories prior to specialization.As such, I completely agree with Dr. Bishop’s
assertion that providing students with inter-professional and collaborative
experiences very early in their training may help facilitate the development of
a more broadly
defined professional group identity.
Jeff Ellison is an advanced student in
the clinical psychology Ph.D. program at East Tennessee State University. In his current externship placement he provides
behavioral health services to patients presenting in primary care and community
health settings across the state of Tennessee via videoconferencing. His
research interests include: the integration of primary care and mental health;
the use of technology (e.g., videoconferencing) in expanding access to
behavioral health care; rural mental health care; and dissemination,
implementation, and quality improvement for primary care and mental health
settings. In his free time, he enjoys running, hiking, biking, and
exploring the outdoors with his family.
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