I have an almost 2-year-old. One afternoon this summer, I turned the TV on "just to catch some news” (and a parenting breather) and Disney’s Ratatouille was on. So, I thought I would break all of AAP’s (revised) rules and allow her to watch some of the movie.
The message of Ratatouille, and the movie’s conscience, Chef Gusteau, is that "anyone can cook!” While characters in the movie struggle with issues of identity, confidence, and social support (as a therapist, naturally I overanalyzed the whole thing), the conclusion is that, while "not everyone can become a great artist – a great artist cancome from anywhere.” This message replayed in my head, over and over. If anyone can cook, and the truly fearless can be great – doesn’t that hold true for MedFT?
I am a MedFT, but train family therapists in a MS/PhD Family Therapy program. Not all of my students are interested, or knowledgeable (yet) in medical family therapy or integrated care. My emphasis is always on how to train general, new MFTs on how to do quality collaboration, especially with systems they are not embedded in (e.g., PCPs located outside their own mental health system). At times I myself have struggled with this identity. If I am a "true” MedFT, shouldn’t I be teaching and training in a MedFT program? Shouldn’t I be identifying only with that group of fabulous people, teaching in a family medicine residency, getting specialized training in fully integrated models, working clinically in medical settings? I recently had a former student ask me, "So, when are you going to get back to MedFT?” I almost didn’t understand what she meant, because that’s who I am at my core. But, her question was about whether I was ever going to practice in a medical home again, because, to her, that’s what a MedFT does. Only, and solely, in one defined area of family therapy.
But, here’s the thing: ALLfamily therapists need to understand the core tenets of MedFT, the skills and techniques of collaborative care, the importance of the biological domain, and the language of medical systems. Whether my students "grow up” to practice in a hospital, or in community mental health does not matter. It’s critical that they use a biopsychosocial approach, and that they advocate for their families to recognize the biological dimension of what they face and for other providers to consider the psychosocial aspects of their shared patients. Please understand, I do not mean that anyone and everyone takes a biopsychosocial approach to care, and that all therapists are also MedFTs. Instead, as Chef Gusteau suggests, "greatness in cooking can come from anywhere.” Any therapist who adopts a biopsychosocial approach and "wants to take seriously the health and relational aspects of their patients’ lives” (McDaniel, Doherty & Hepworth, 2014, p. 8) can be a MedFT. My students have equal opportunity to pursue education, training, and practice in this approach, and must be pushed to think outside their psychosocial cookbook.
As the movie suggests, family therapists may only be limited by their soul, not by where they come from; MFTs interested in thinking about larger, medical systems "must be imaginative, strong-hearted.” Further, "you must try things that may not work, and you must not let anyone define your limits because of where you come from.” The only limit, for a family therapist from general MFT origins, is whether they adopt a biopsychosocial approach, prioritize collaborating with medical professionals, and seek to consider healthcare providers and systems in their clinical work. Regardless of training background, a philosophical orientation to families and working with them is key. As I teach my family therapy students – educate yourselves about chronic illness, be brave and approach physicians to share care, read literature outside family therapy-only journals, and include the biological dimension in your treatment plans. They’re capable, just not quite as confident as perhaps students coming from MedFT-specific training programs. Which, I suppose, says something about me too: as a MedFT educating family therapists who may or may not be interested in my obsession, it’s important I train for confidence as well as skill, and model confidence in my own self-knowledge and professional identity.
Although I made sure to turn the TV off after 20 minutes of co-viewing…Chef Gusteau’s mantra stayed with me. Not everyone will become a Medical Family Therapist, but a great MedFT can come from anywhere.
McDaniel, S. H., Doherty, W. J., & Hepworth, J. (2014). Medical family therapy and integrated care(2nd ed.). Upper Saddle River, NJ: Pearson Merrill Prentice Hall.
Sarah Woods, PhD, LMFT-Supervisor is an Assistant Professor and Program Coordinator of the Family Therapy program at Texas Woman’s University in Denton, TX. She graduated with her MS in MFT from the University of Rochester, and PhD in MFT from The Florida State University. Her research focuses on the connections between family relationships and physical health outcomes, especially for underrepresented adult populations.