Our masters students at Drexel's Couple and Family Therapy Department who have done internships in medical settings (e.g., HIV, oncology, and primary care) often experience culture shock when they first begin their placements. As a supervisor, I have normalized this initial culture shock because I believe that learning about the medical culture is like moving to another country where the language and customs are different. I remind students that they will eventually become more familiar with the medical language and concerns of physicians and will learn how to collaborate and consult about patient care and family issues.
As a program we make sure our interns are placed in collaborative medical settings, where they are able to ask questions and to learn from medical providers and where medical providers are open to learning about family-centered care. Our students often rely on physicians to make referrals to them so as a supervisor I help students learn how to translate the medical concerns of physicians, for example medical compliance and treatment retention, into a psychosocial or family problem that they can work on collaboratively with the provider and with the patient and his/her family. I believe that family-centered care occurs when two cultures learn from each other, allowing medical providers and family therapists to collaborate, partner and work together in order to provide more holistic and family-centered healthcare.
Initially most interns have felt out of place or like they do not fit into the medical setting. Although our students have found it is much easier when another family therapy intern was placed at the medical clinic before them, it is still an adjustment and culture shock regarding the pace of care (e.g., learning how to do 10-15 minute therapy sessions vs the typical 50 minutes), medical language and terminology, and hierarchical medical model. Again, I remind my interns that fitting in will take some time and will improve as they begin to collaborate on shared cases with medical providers.
However, my students have also shared that they struggle with the differences in approaches to care and techniques. Physicians tend to focus on short-term goals, focusing on very specific problems or tasks (e.g., taking medications as prescribed) but also tend to follow their patients over several appointments. Family therapy interns often feel they need to do more lengthy sessions with families. Although this can be helpful, patients in medical clinics have become impatient and some refused family therapy unless it can be integrated into their regular health care at the clinic. I think this is the biggest challenge for beginning medical family therapists and for me as a supervisor. I would like to hear about other strategies that can help trainees learn how to do effective shorter-term therapy in medical settings.
In general, I am also curious about what has worked or not worked for other faculty, supervisors and providers to help interns and family therapists find a place in the medical home?
||Maureen Davey, PhD LMFT is an Assistant Professor in the Couple and Family Therapy Department of Drexel University. She is a member of CFHA.|