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If I Knew Then What I Know Now: Research As Reflection

Posted By Christina L. Vair, Tuesday, September 23, 2014

Christina Vair, PhD, is the 2013 CFHA Fellowship Award recipient. Below is her reflection on her research project.

As the old saying goes, “hindsight is 20/20.”

With the 2014 CFHA conference nearly upon us, I cannot help but think back on last year’s conference, in particular, my receipt of the 2013 CFHA Fellowship Award. In doing so, I have found that oft used phrase referenced above coming to mind regularly. Looking back over the course of this past year, I appreciate how this particular project was inspired by and, in many ways encapsulates, my own professional journey. Though I am certainly excited to present the findings of my study on advanced psychology trainees’ perspectives on preparation for practice in integrated care settings, this forum grants me the unique opportunity to reflect on the process of conducting this research, rather than just the outcome. Through undertaking this project, I have been provided with an opportunity to reflect on my own learning over the last several years and contemplate where I’m headed in the future.



My interest in developing an academic understanding of the primary care psychology trainee perspective is rooted in my own personal training experiences. I first stumbled into the world of integrated care during my last year of graduate school.  Though I was quite naïve to the concept of integrated care at that time, I was none-the-less tasked with providing brief assessment and treatment to older adults attending a day heath care program. What might have simply been a one-time, “been there done that” training experience touched off a desire to develop a career as a psychologist in integrated care. This was the first time in my training as a psychologist that I felt as if things really “clicked” for me. The whole person, patient-centered approach to care, the consideration of the interrelationship between mental and physical health, and the dynamic, team-based approach resonated with me on many levels.   

From that first experience, I was hooked. I had found my professional “home.” Next came an internship with emphasis in behavioral medicine, then a postdoctoral fellowship focused on primary care-mental health integration with the Department of Veterans Affairs Center for Integrated Healthcare. These increasingly focused opportunities further opened doors that solidified my dedication to integrated care, and in turn, my desire to learn more about what other trainees like me were experiencing in their journeys into primary care psychology.  As the intensity of my training increased, I found myself regularly wondering how other trainees found the path to primary care psychology, whether they too intended a career in this field, and what they needed to succeed in this pursuit. These questions set the stage for my research proposal to investigate the trainee perspective, particularly as a review of the literature on training models for behavioral health providers in integrated care appeared to lack this consideration.

I found myself thinking, "what if I knew then what I know now?" 

Flash forward to a year later. A survey was designed, distributed nationally, piloted along with the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)1, a recently developed measure of fidelity to model adherent behaviors in providing mental and behavioral health care in integrated care settings. Responses from across the country trickled in, and a data set was born. Analyses were undertaken, and various themes emerged. All the while, with each iterative step, I found myself learning new and different things.  I found myself thinking often about my own professional path, and wondering, “what if I knew then what I know now?” 


One particularly salient response that I found myself pondering in relation to that question was a desire to learn to embrace the inherent challenge of having dual identities. One particular duality that sprang to mind was how to balance being both a clinician and researcher. Though I had been training as a “scientist-practitioner” since graduate school, conducting this study was truly the first time that I authentically felt like a “scientist” thus far in my career. Within scientist-practitioner programs, students are theoretically taught to equally value clinical practice and research, and to appreciate the reciprocal and potentially mutually beneficial relationship between the two. Though internship had helped me feel as if I had developed solid clinical “muscle,” my sense of identity as a scientist was comparatively puny. I found that I had learned to “walk the walk” as a clinician, but was not yet comfortable in my ability to “talk the talk” of a clinical scientist. 

Having had several rich opportunities to explore assorted supportive roles on research teams prior, this project represented my first foray into the role of a principal investigator. Up until this point, I had learned the basics of integrated care in a mostly experiential manner, and found my knowledge wanting in regard to the theory behind the practice. Delving headlong into the scholarly literature on training models, core educational components, and the development of competencies for practice in primary care psychology provided a solid foundation for learning the language of integrated care. Understanding and adopting this lexicon has facilitated my ability to not only articulate more thoughtfully and concisely what it is I “do” as a psychologist in primary care, but has also helped me define where I see myself going in the future. Further, exploring and engaging with this literature has also helped me develop an awareness of the gaps in my own training thus far, and presented the opportunity to develop goals to address the areas in which my own competence lags.

This lexicon helped me define where I see myself in the future 


So where do I go from here? How do I use what I have learned from this experience to move forward, to continue to develop as an integrated scientist and clinician, and help shape the field of primary care psychology? Research is of little use if it’s not disseminated. Then of course every good study has a “Future Directions” section. 

As another old saying goes, “the journey of a thousand miles begins with a single step.”      



1. Beehler, G. P., Funderburk, J. S., Possemato, K., & Vair, C. L. (2013). Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: A Delphi study. Implementation Science, 8(19). doi:10.1186/1748-5908-8-19


Christina L. Vair, PhD is a licensed clinical psychologist with the Center for Integrated Healthcare (CIH) at the VA Western New York Healthcare System (VAWNYHCS) in Buffalo, NY.  Prior to her current role as a clinical researcher, she completed a two-year postdoctoral fellowship with the VA Advanced Fellowship Program in Mental Illness Research and Treatment (MIRECC) with the CIH that focused on improving the health of veterans through enhancing primary care-mental health integration. During her post-doc and internship with the VAWNYHCS, Dr. Vair provided mental and behavioral health services in primary care, chronic pain management, behavioral medicine, and long-term care. Dr. Vair earned both her MA and PhD in clinical psychology with emphasis in Aging and Geropsychology from the University of Colorado, Colorado Springs. Her research interests including exploring mental health concerns of the aging population within the primary care (PC) medical setting, dementia screening and treatment in PC, and improving the implementation of primary care-mental health integration through provider training, fidelity assessment, and the utilization of measurement in guiding care.  

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