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5 Questions with Jennifer Hodgson

Posted By Dan Marlowe, Tuesday, June 05, 2012

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Dan Marlowe: The following is an interview I conducted with Jennifer Hodgson, PhD, LMFT. Dr. Hodgson is a Professor in the Departments of Child Development and Family Relations and Family Medicine at East Carolina University in Greenville, NC. She was instrumental in developing and starting the first Medical Family Therapy doctoral program in the nation, and continues to be an incredibly passionate supporter of not only MedFT but of collaborative and integrated care in general. On a more personal note, Jennifer has been instrumental in my own professional development from a directionless undergrad with lots of energy, to a master’s student trying to focus that energy to feel competent sitting in the therapy room, and eventually the exam room, to a stubborn doctoral student trying to hone that energy in the right ways to express his views. She was, and continues to be a mentor to me and many of my colleagues. So, without further ado and emotional hemorrhaging, here is my interview with her.

 1: What experiences in your personal/professional life do you feel were most instrumental in your development as a medial family therapist?

JH: A lot of it had to do with experiences around illness in my own family, and my feeling that we (the healthcare system/providers) could be doing a better job at promoting overall health. I think medical family therapy was my way of hoping to address that later on down the road. In the end I saw, in a very personal way, the effect that providers not-talking, not ‘collaborating’ had on how care was delivered, as well as how patients and their families suffered because of that silence.

In terms of my education, even before I started seeing patients, while I was still in training, issues would come up in terms of vignettes or case examples and it seemed like there was more to the story than just the psychosocial. It seemed, at least to me that by compartmentalizing the issues we, as students and eventually clinicians, were missing the larger context and the medical piece was part of that. I/we needed to understand medical language, medical culture, and most importantly for me, I needed to get over my own ‘hero worship’ of physicians and the running thoughts that- "You don’t bother the doctor and…defer…defer…defer.”

When I did my fellowship at The University of Rochester, I realized everything I had been taught in graduate school to this point had to be amended. I stepped into an environment that seemed to be moving at a million miles an hour around me, and I was seemingly standing still. It was an adjustment working in a primary care setting. I describe it like when you first learn to drive and master the city roads. Then, you get on the fast paced highway and learn quickly that just because you have to drive faster doesn’t mean you drive worse. You do need to adjust your reaction times, pay attention to other fast moving things around you, drive smarter and more efficiently, but sooner or later you feel comfortable and ease into cruise control mode. Walking into the world of MedFT gave me the authority to have conversations that would have been previously considered outside of my scope of practice had I just operated off the skillset taught thus far. Getting specialized training in integrated primary care was critical and essential and I am grateful for my time in Rochester with Susan McDaniel, Barbara Gawinski, Dave Seaburn. Nancy Ruddy, Pieter Leroux, Tom Campbell, and many others because of it.


2: What do you feel is your greatest contribution to the field?

JH: I really feel like the Medical Family Therapy doctoral program has been my greatest contribution, thus far. I, and the rest of the faculty at East Carolina University, felt like we needed to fill a gap, and that the best way to go about that was to develop a place where we could train the trainers and develop the researchers. Our goal is to develop professionals who can execute responsible and high-quality research, not just about MedFT, but about how relationships impact health and healthcare delivery. My colleagues and I want our students to be leaders in healthcare, biopsychosocial researchers, and go on to create even better MedFT training programs. That’s what you always want from and for your students, you want them to go out and do it better than you did. Of course none of this would have been possible without the vision of my colleague Mel Markowski (retired), co-authoring of the program with Angela Lamson, and support of many administrators and my talented co-faculty members David Dosser, Damon Rappleyea, Mark White, and Wayne Hill (retired).


3: What do you think MedFT, as a field/orientation, needs in order to move in mainstream healthcare?

JH: We definitely need a louder voice at the advocacy/policy making level, which is hard since we are such a small group at this point. There are all of these panels and committees on healthcare matters springing up nationally, and a lot of organizations are making concerted efforts to place their members on them. It just seems like this is a point in time in healthcare where things are moving so fast, if we do not move at the same pace, we are going to get left behind and consequentially so will all that we stand for and represent: the patient in a family, the systems surrounding them, and the relational aspects of integration. We need to start thinking strategically about how to expose ourselves to the agencies and people making the decisions, as well as the population in general. We need to get more data regarding our work as MedFTs, which we have some of, but that is only half of it and maybe the easier part. The harder part is getting that data to the right people, and that is where I think we have had a rough time so far.


4: What do you think we lack, in terms of training that puts us behind some other fields?

JH: Well, if we are talking strictly about family therapy as a field, and not Medical Family Therapy as an orientation, then, and I know people are going to hate to hear this, we need to require our students to learn how to work in medical settings and adopt more evidence based brief therapy approaches. A lot of healthcare institutions and insurance companies want clinicians to demonstrate use in these types of modalities, and if our students have little to no formal training in them we are at a huge disadvantage. I’m not saying that we abandon traditional family therapy modalities; I am saying that students need exposure to brief models of therapy and augmented models of therapy that have a systemic/relational bent. However, we are talking about an endpoint here, and where we need to start is re-training our faculty to prepare students to work in healthcare settings. We need a national initiative for workforce development like other professional organizations and that takes money.


5: Ideally, where to do see MedFT in the next 10 years?

JH: I agree with many of our colleagues that medical family therapy should not just be about family therapy as a profession. I do, however, feel that family therapists make good trainers regarding MedFT because they’re inculcated with systems and relational thinking from the time they begin their own training. MedFT should be about training/teaching people (regardless of profession) how to think and work systemically not only from a direct care standpoint, but how to think and work in teams from a healthcare system standpoint. I don’t think the name Medical Family Therapy is the problem like some have said: I think it continues to be portrayed as a problem because of the inherent silo’ed thinking of our professions. Medical family therapy is and should be much larger than those who are licensed marriage and family therapists and work in medical settings. I don’t care if you are a psychologist, social worker, nurse, physician, or family therapist, I think in order to call yourself a medical family therapist you need specific training in how to work with couples, families, and larger systems. We get stuck in our dialogue about MedFT when we think about and rely too heavily on the words "family therapy.” What we need is to focus our efforts on the continuum of training that is available for those interested in expanding the system for research and clinical purposes. MedFT may require more or less training in family therapy depending on how one wants to apply it but we all should be mindful that patients leave our offices and go out into the community and to their homes where their interactions in those places are the real determinants of health.


Jennifer Hodgson

Jennifer Hodgson, Ph.D., LMFT is a clinical member of AAMFT, an AAMFT Approved Supervisor, Chair of the Commission on Accreditation for Marriage and Family Therapy Education, Chair of the NC Marriage and Family Licensure Boardand long time member of the Collaborative Family Healthcare Association and Society of Teachers of Family Medicine. She is Immediate Past President of the Collaborative Family Healthcare Association.

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