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A Call for Patient and Family Centered Care

Posted By Daniel Marlowe, Tuesday, April 3, 2012

As healthcare costs continue to increase, the squeeze of providing affordable high quality care continues to be at the forefront of the debate. One possible answer has been to explicitly include family members and social support systems as key players in helping provide care to patients. No longer seen as only a ‘resource,' family members are being looked to as cornerstones in ensuring patients receive the best care possible. This link presents an AARP report entitled Moving Toward Person- and Family-Centered Care, which outlines PFCC in regards to older adults with chronic illness and/or disability.

Something to consider- as the healthcare field continues to place a higher premium on patients' relationships and connection to social supports as a means to defray gaps in care, how might medical family therapy position itself to help this discussion along? After all, as medical family therapists we know the power of these relationships, their effect on our biopsychosocial well-being, and perhaps most importantly, the difficulty many families face in taking on the care of a loved one. Perhaps this call for family involvement is a concurrent call for MedFT involvement as well?

References:

Feinberg, L. (March, 2012). Moving Toward Person- and Family-Centered Care. Retrieved from http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2012/moving-toward-person-and-family-centered-care-insight-AARP-ppi-ltc.pdf

 

Daniel Marlowe

Dan Marlowe is the co-editor of the Growing MedFT Blog, and the Director of Applied Psychosocial Medicine for the Duke/Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC. He obtained his MS in Marriage and Family Therapy and PhD in Medical Family Therapy from East Carolina University in Greenville, NC.


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The Knock

Posted By Lisa Tyndall, PhD, Tuesday, March 27, 2012
The sound is a familiar one. I have heard it at my primary care physician’s office, my gynecologist’s office, my pediatrician, the mammographer, and the ultra sound tech room, two quick knocks and then an entrance. Whoever follows that knock brings with them several things. Among those items is usually a sense of respect, knowledge, authority, news, caring, sometimes curing, and always a sense of privilege. They belong there, it is their space and I wait for them to share with me what they know.

So who am I to be on the other side of the door? Could I be a "knocker"?

These are two of the questions that I battled with as I entered into my first integrated care internship. I was told to check the sheets for patient information, go into the room, and introduce myself and my services. But this would require me, very quickly, to become confident in not only my role in the healthcare agency, but also in myself. I would have to be the one on the other side of the door. You know, the one with the "respect, knowledge, authority, news, caring…etc.” Who? Me?
Lisa Tyndall

"So go ahead, knock. Knock respectfully, kindly, and firmly, but knock.

You’ll be amazed at the doors that open."


 As medical family therapists, we have battled for acceptance as a valid and worthy and reimbursable service. Our western culture has long appreciated the seemingly solid science of medicine, but it has shied away from fully endorsing the impact of the psychological, social, and spiritual impact on our physical health. This disparity can leave the burgeoning medical family therapist feeling somewhat timid as he/she enters into a medical context. But this disparity must be overcome and must be overcome within the provider him/herself.

If medical family therapists are going to be successful in a medical context, we must grow in our confidence in ourselves and in the services we offer. While this probably comes naturally to those who have been practicing for longer, in students it may show itself in two ways. It may manifest in an intern with an overly-confident demeanor or an intern who is so hesitant that they think their services are an intrusion into the patient’s "normal visit.” We must learn to strike a balance between confidence in our services and place in the medical setting, while remembering one of the core components of family therapy, humility in what our patients and their families can teach us.

The balance is rooted not only in our belief in what our profession and services have to offer, but also a belief in ourselves. As individual providers, we must work to be as self aware as possible in who we are and any issues that might be hindering our ability to gently assume our place within the medical system. We must believe in ourselves that we can carry out what our mentors and professors have taught us about our profession and role in the healthcare industry. And as is true for so many things in the therapy world, this is isomorphic to the patients and families we work with. As we embrace the value in our work and in ourselves, we will likely impart that belief to our clients and the other providers with whom we collaborate. Perhaps they will learn that they too are valuable.

So go ahead, knock. Knock respectfully, kindly, and firmly, but knock. You’ll be amazed at the doors that open.

 

Lisa Tyndall is employed as the Clinic Director for the East Carolina University (ECU)Family Therapy Clinic in Greenville, NC. She has her license in Marriage and Family Therapy, and received her doctorate in Medical Family Therapy where herdissertation research focused on developing a consensus definition of MedFT. She is the beaming mother of two fantastic young boys and adoring wife to her husband, Richard, of almost 13 years.

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Growing the Collaborative Network...the "Old-Fashioned" Way (Well, OK, Not by Telegraph...)

Posted By Julia B. Sayre, MS, LMFT, Tuesday, March 20, 2012

I've just placed a call to a family practitioner, and faxed the release. I notice I'm feeling expectation, curiosity and a strange sense of girding for possible disappointment. I've never worked with this doctor or this practice before. Though rare, there is the occasional practitioner who just does not call back. Collaboration still, at times, feels like a bandwagon for which I'm extending invitations.

Success! The physician a) calls back within about an hour and b) I am able to answer the phone! I briefly summarize how I know our mutual client/patient (Pient? Clatient?), ask for confirmation of the medication dosage and both ask for and impart information regarding reactions to the medication. I am able to report that, based on a recent session with the patient's spouse, the medication's presumed effects garnered a glowing report: she feels better, as reflected in her reports to and interactions with her spouse. The doctor notes this, and comments that the patient never returned for a medication follow-up appointment. Note to self: This doctor does ask patients for follow-ups – my kind of practitioner! I offer to address the need for a follow-up visit to the doctor with our client when she and her spouse come to see me next week. I also ask about a medical condition the client reported – known to have a side effect of depression – and am able to update the doctor about how the client is doing relative to those symptoms: Data for the doctor.

"That went well!” I'm thinking, and then, since I'm sharing this experience, "How so?” It reduces to two major factors: the richness afforded by telephone communication combined with the availability – and good scheduling luck – that enabled prompt exchange of information.

Julia B Sayre

We could conspire to bring me into the 21st century – EXCEPT: there is a difference in communication substance when we write to our medical colleagues compared to speaking with each other. I could email questions and updates. That's fairly straightforward, but lacks the richness of data that occurs when two people converse.

 Phone calls and phone tag or email, oh my!

No question, email could expedite contact with physicians; I know, and I confess: I don't trust that I have what I need to protect client identity, and this keeps me from transmitting via the internet. I am expecting a chorus of suggestions on this (honest, I can't see you rolling your eyes) and welcome every single one, thanking you in advance. We could conspire to bring me into the 21st century – EXCEPT: there is a difference in communication substance when we write to our medical colleagues compared to speaking with each other. I could email questions and updates. That's fairly straightforward, but lacks the richness of data that occurs when two people converse.

I recently checked in with a doctor regarding a new, elderly client of mine about whom I have concerns regarding cognitive functioning. The doctor reported updating three prescriptions in her first appointment, all psychoactive, which our mutual client had just reported to me she was no longer taking, though they had been prescribed for 90 days only three weeks ago. In exactly two minutes, the doctor and I clearly understood each other. Though she had observed her patient as alert the day of her physical exam, she volunteered to do some cognitive screening and carefully inquire about medications at the follow up her patient had not yet scheduled – but that I would encourage the client to seek: A multidisciplinary dance enhancing client care. That is what I hope for: the richer data, that feedback that happens when, as participants in collaborative care, we are able to discuss factors impacting emotions, illness or medication.

Availability

Emailing information eliminates the concern about availability and schedules— though typing takes me longer than talking! I edit, and double-check, and it takes twice as long; so though I've now delivered the written message perfectly, there is no guarantee about the timing of responses to my information and questions – and it may be that the doctor's responses will create follow up questions.

In the above examples, notice the doc and I each were available to the phone when the other called. I happened to be available at the same time she was – a seeming miracle in this day and age. Doctors will often tell their staff, "Just pull me out of an exam room if a colleague calls.” But as a MFT, I don't have that "luxury,” nor do I want it: I personally hold to not interrupting client sessions to answer the telephone, similar to most of my MFT colleagues. Mutual availability is the barrier to direct, interactive communication, but is so worthwhile to getting the richer data and helpful informational exchange that I seek.

Building the Collaborative Care Network One Quick Call at a Time

We all need a rubric: Whether we're requesting information and sharing it via letter, email or telephone with a medical practitioner, we probably have a preferred list of questions. And alternatively, if we're making a referral, it's useful to have a standard presentation: we've seen the client for this long, diagnosis, purpose in referring. Doctors tend to talk in short, purpose-driven sentences, right to the point. We therapists ponder the human condition and wonder about possible outcomes. I've learned to keep it short and sweet, tailor a basic set of questions to the needs of the individual client's situation, focus on the answers so that I can attend to thorough, though brief, follow up questions; this is my compromise to seeking "richer” data by telephone, but following the "all-business” route. The good news is that, if you catch the doctor between your clients, there's a good chance you will get the information you need quickly. They talk fast, and I talk – and listen – as fast as I can!

And final thought: Since I do things by telephone, I almost always offer to send cards, and I ask them to send some in return, once they receive mine. We create networks, we become familiar with each other's treatment philosophies, and we become a community of collaborative care practitioners!

Julia B. Sayre is a licensed MFT, Certified Traumatologist and AAMFT Approved Supervisor practicing in Northern Virginia. Julie holds an avid interest in medical family therapy, supported by a strong belief, steeped from the first days of her clinical training, in the collaborative approach. She received her B.A. from the University of Virginia, her M.S. in Human Development/MFT from Virginia Tech/Falls Church, and maintains ties to VT through the occasional service on a thesis committee, most recently regarding original research in medical family therapy. She also serves on the Board of VAMFT, Virginia's division of the AAMFT, and is a member of ISST-D. She and her spouse form a stepfamily, "whose genogram looks something like a hybrid tree-shrub with a few hanging vines. With really nice flowers.”

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So Now We Don’t Have a Father? One Widowed Parent Answers Tough Questions

Posted By Sonya Jones Dawson, Tuesday, March 13, 2012
My daughter is the typical 7 year-old in that she asks a lot of questions. And there is a lot in her life to question. We had a baby last year and she wants to know how that happens. She saw me go through pregnancy, the changes in my body, and had the waiting experience. She heard his heartbeat more than once and felt him move inside me. Still, at 6 years-old, I imagine it's strange to go through all that only to be brought to the hospital one day and told, "Okay, he's here and have this tiny person just appear. She adores him. He's her best friend. She still has questions about not so much where he came from, but how he got in there. Not a conversation I'm ready to have with a 7 year-old. I told her that God helped her father and I make them. She did see an animal planet special on the subject. It included talk about the egg and sperm. I did let her know that people made babies the same way. That's as far as I've gone.


Then we weren't settled into life with her little brother when her father, whom she loved dearly, and who was sick most of her life died one day while she was at school. He wasn't terminal. I didn't tell her he was dying. I didn't tell her he wasn't. She asked. I just told her that she'd be taken care of no matter what happened.

She was always concerned for his comfort and that has not changed since he died. I think she worries just as much about him as she does about me. I remember taking a significant amount of time letting her know how soft the pillows inside the casket were and how he was wearing his favorite suit. Still death is a huge mystery to anyone who hasn't been there no matter what their age. At the age of 7, there's another whole level as far as an inability to understand the concept.
Sonya Jones Dawson
I sit in wonder as to the inner workings of a child's mind.

"Doesn't he need food?” "No.”


"Is he okay?” "Yes because he's not sick anymore.”


She made him a get well card after he died similar to how she would periodically during his life. I told her he wasn’t sick anymore, but unfortunately that also meant he wasn’t coming back. I asked if she’d like to put the card in the casket, but she declined. Instead we gave the funeral home a bracelet to put on him that she’d given him for Christmas. It was a gold ID bracelet with "DADDY” on it. They put it on his right wrist along with a gold bracelet I had given him for a previous anniversary.

She was able to see him the day before the funeral and checked him over thoroughly while standing guard as others came and went. I looked at her in between greeting visitors and shook my head at the thought of the confusion she must have been feeling. She asked me whatever she wanted to ask though. Mostly she wanted to know why he wasn’t doing various things. "Why isn’t he breathing?” "Why isn’t he talking?” "Why isn’t he moving?” I had to keep saying "People don’t (insert activity) after they die.”

Then it was on to the concept of burial. How do you explain to a 6 year-old that beyond being put in a box, we also have to put her father in a hole in the ground? However a person finds the words that will work is all I can conclude. I found though that explaining it once doesn’t mean the conversation won’t take place again. For Ariana this was hard to accept because her father really valued being clean. He worked and the first thing he always did after work was take a shower. He hated being dirty, and his daily shower was very important to him, especially during the summer months. She looked at him and knew he would never get a bath again. I told her we could not keep him at home anymore because after a person dies they have to be kept in a special place. They need that special bed and the bed has to go into a special box. I explained it was all being done to keep her father safe and clean and that once it was done he would not need another bath. That explanation satisfied her and fortunately for me, it satisfied her all four times we had the conversation since we buried him.

It still took her a while to realize it was permanent. After about 6 months she began to ask me continuously for weeks if he really was going to be gone forever. But I didn't mind. I still look at the door and can’t believe he won’t be back so I can’t imagine how difficult it is for her, so I don’t hesitate to answer her. I mean I hate for her to have to deal with the reality, but I imagine it is better for her than expecting that after a certain length of time he's going to come bouncing through the front door like he did before he died.

I have a friend who lost her husband when their daughter was the same age as my daughter is now. She found out later that the little girl just thought he was going away for a while to get better, that she didn't know when, but thought he'd eventually come home. It was 3 years later she said when the reality set in, and it hit her so hard she started lashing out at friends she'd had since preschool because they still had both of their parents. She said it was so bad she had to change schools. And I've read this is normal, that children grieve in cycles, so I'm still on guard. But with counseling that little girl has blossomed into a beautiful teenager who has helped other girls who have experienced the loss of a parent. I expect she'll help my daughter at some point. And I expect at some point my daughter will be helping others.

As recently as last month, she voiced some concerns. Some were repeats, but still I sit in wonder as to the inner workings of a child's mind.

"Doesn't he need food?” "No.”

"Is he okay?” "Yes because he's not sick anymore.”

"Is he our angel now?” "I'm not sure, but I believe you have always had one or more. (that’s another story). If he's not one of them, I'm sure all the praying he did for us has sent us some.”

"Can he see us?” "If he's one of our angels he can. If not, no.” (And on my angry days I hope not. I get so angry. And I’ve made some changes in my life I know he wouldn’t be happy with and I’ve invested in things he wouldn’t have. But I’ve done what I felt I needed to do to survive and since he died, he doesn’t get a vote).

Then, the conversation got even more interesting.

"Does he still snore in that bed?” To explain the concept of a casket on her level I called it a special bed. "Absolutely not. He isn’t snoring.”

"Oh, is that because he doesn't breathe?” "That’s right.”

"So, is he bored?” "No.”

"Mommy, why did you marry an old man?” "Huh? He was 45. That's not old.”

"Well, only old people die right?” "Um…no honey. Anyone can. It's sad, but anyone can no matter how old they are.”

I shake my head at her having to deal with such harsh realities at this age. I worry it will make her grow up too quickly. I remember the day it happened. I remember thinking of telling everyone I had to tell, how it was going to hurt them. For her I felt I was going to take part of her innocence. My heart began to beat faster when Ariana's Godmother left our house to bring her back home. And it progressed to racing when they returned and Ariana came bounding up the steps to our front door. I was about to turn her world upside down. How could I do this?


I didn’t wait. As soon as she was inside the door, I took her hand and walked to her father’s chair. I sat and held her close to me. We had talked about death when she asked about my grandfather. He died when she was two years-old, but his picture is up in our house. So, I went from that. "Ariana, do you remember when I told you that sometimes people are hurt or they get sick and the doctors can’t fix them? "Yes.” "We talked about how when that happens the person goes away to be with Jesus if they believe in Him right?” "Yes.” "Well, honey, daddy went to be with Jesus today.”

She was the calmest person I talked to that day. But her quiet tears tore through my heart in those moments and still do. And I'll never forget her words...

"So, now we don't have a father?”

But I continue to be inspired by how she handles not having a father. And I pray that God continues to equip me as He has been faithful to all the way to now, to handle my children not having a father. It isn’t easy. The truth is I have never been more tired in my life. But I’ve also never been more grateful. My children are beautiful and the greatest things my husband and I accomplished together. I’m sorry he doesn’t get to see it, but my appreciation to him for giving them to me, outweighs the sorrow enough that I keep putting one foot in front of the other for him, for our children and for me.

Sonya Jones Dawson is a Clinical Data Analyst in North Carolina. Thomas and Sonya were married for 10 years. During that time Sonya cared for Thomas as he courageously battled the effects of Lung disease. He had bouts with lung infections, heart disease, steroid induced osteoporosis and diabetes that resulted in intermittent periods of incapacitation ranging from two weeks to 7 months long. Sonya joined the Well Spouse Association in January 2008 shortly after Thomas' diabetes diagnosis.

Sonya and Thomas had two children from their marriage, and two children from Thomas' previous marriage. On March 9, 2010, two months after the birth of their second child, Sonya returned home to find Thomas had died in his sleep while she was at work. Sonya and their two young children continue to live in the family home in North Carolina. Their daughter Ariana is now eight years-old and their son Elijah is now two years-old. She continues to be an active supporting member of the Well Spouse Association.

This post was re-printed with permission from the Wellspouse Association, which "advocates for and addresses the needs of individuals caring for a chronically ill and/or disabled spouse/partner.” Please follow this link to learn about this wonderful organization.

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Dejected Views on Family Hating

Posted By Barry J Jacobs PsyD, Tuesday, March 6, 2012


Dejected Views
on Family-Hating


Barry J. Jacobs



 The surreptitious eye-roll is bearable. The low groan is regrettable but not worth reproaching. But what irks me most about the occasional reactions of my family medicine residents to their patients’ relatives is the smug, dismissive, professionally rendered character assassination, complete with technical terminology. "The spouse is in denial,” they point out to their fellow inpatient team members when an overwhelmed and grieving husband or wife is unwilling to change a patient’s code status. "The daughters are being manipulative,” they observe about adult children who are urging their mother to resist physicians’ recommendations to undergo surgery or take a new medication. "They’re over-stepping boundaries,” they claim about family members who call them repeatedly or accost them with concerns in the hospital or office hallway.

It’s not that other healthcare professionals are substantively more family-friendly. For many of my mental health colleagues, hate of (or at least discomfort with) families is a many splendored thing. They focus on individual dynamics and prerogatives, invoking the delicateness of the therapeutic alliance or the sanctity of confidentiality as justifications for eschewing family contact. They cringe at the prospect of family meetings. They regard family systems thinking as a relic of the ‘60s, unsupported by current research or modern expediency.

I’m incredulous at these attitudes; I take them personally. From my teenage years caring for my father with brain cancer to my middle-aged years caring for my aging mother and demented step-father, I know in my gut how families affect patients’ clinical outcomes and how patients’ illnesses affect family caregivers. Others, clearly, don’t share the same visceral conviction. So what do I make of the widespread phenomenon of family-hating? Here are some over-the-top theories:

We operate in evidence-reinforced comfort zones: Much of healthcare practice and consequently research is focused on individual patients. In an era when clinicians are reminded at every turn to treat according to evidence-based principles, family-centered practices—lacking the same degree of empirical support—therefore seems the riskier clinical gamble. This is compounded by the fact that many healthcare professionals do not receive much training in the nuts-and-bolts of working with patients’ family members—e.g., running family meetings, addressing family conflicts. The seemingly prudent and comfortable treatment approach is centered on patients, leaving family members in the wings.

We are rats in templated, encoded mazes: Medical care, especially primary care, is being increasingly shaped by the clinical pathways that are the basis for the templates of our electronic medical records. By clicking through those templates, physicians not only have the assurance of following the so-called highest standards of care but are also working toward completing their progress notes for medical sessions as quickly as possible. It should come as no surprise that those EMR templates reflect bias toward individually-focused treatments. Family-centered healthcare is off-the-templates.

At the same time, clinicians are under enormous pressure to maximize reimbursement for healthcare services. The billing codes—aka CPT codes—they use have a powerful effect on practice. CPT codes for individually-oriented treatments are reimbursed by insurance companies. CPT codes for meeting with patients’ family members are generally not. We follow the money and avoid the family members.

Beaten and bedraggled, we cling to our authority: I don’t need to tell you that every year healthcare providers are worked harder, blamed more for rising healthcare costs, and disparaged more frequently by angry patients and aggressive lawyers. Evoking Rodney Dangerfield, all we want is a little respect. Now comes the dawning age of the patient-centered medical home with its emphasis on team-based care and who wants a place at the decision-making table as partners in care? Family caregivers do. (For example, see this recent AARP Public Policy Institute report). I think it’s tough for us to give up some of our remaining power to family members. When I hear professionals complain that patients’ family members somehow obstruct the treatment plans of the healthcare team, I infer that they don’t want their scant authority challenged any more than it already has been.

We are all adolescents at heart: Many of us give lip service to the importance of family members to patients’ care. But in our own lives, in our heart of hearts, we feel ambivalently about families. We want their support but don’t want them to encroach on the individual’s rights and independence. It reminds me a little of the sentiment captured in the title of the 2002 book on teenager psychology, Get Out of My Life, but First Could You Drive Me and Cheryl to the Mall. We want family members to drive our patients to our offices but then don’t make a fuss in the exam rooms. We want them to help our patients adhere to our treatment plans but not have input into those plans. That’s not family-centered care. That’s not even respectful of what family members know and have to offer. It marginalizes families. It’s reflexively oppositional and hateful.

For more on this general subject, check out the seminal article, "The Trouble withFamilies: Toward an Ethic of Accommodation” by Carol Levine and Connie Zuckerman in the Annals of Internal Medicine, 1999, vol. 130, pages 148-152.

Also please see "Interacting with Patients’ Family Members During the Office Visit” in the Oct. 1, 2011 issue of American Family Physician; it’s a tepid, timid approach to incorporating family members into primary care but at least represents some effort to do so.

 



I Beg to Differ

David B. Seaburn

 

I beg to differ with my good friend Barry Jacobs’ blog posting entitled, "Dejected View on Family-Hating.” Not only is he (uncharacteristically) off-base, but he may not even be on the playing field.

He notes that family-hating is rampant in the medical field as well as in most mental health disciplines. While I don’t espouse family-hatred, I doubt that any well-trained family-oriented mental health professional isn’t at least ambivalent about families from time to time. They are messy and confusing and inconsistent and wonderfully Resilient in their efforts to get us to respect their integrity. Non-family-oriented healthcare professionals are not the only ones to unfairly label families. In moments of frustration, I have considered whether "borderline” might be an apt relational diagnosis, especially when I don’t know what to do with a family.

Which brings me back to Jacobs’ criticism of residents. If as an experienced family therapist (35 years), I, at times, label and very nearly hate a family, what can be expected of residents. Remember---these are medical professionals who have been trained almost exclusively in a paradigm that focuses on the life and death of an individual patient; who have been acculturated to think reductionistically ("Let’s find the single cause of this patient’s symptoms”); who then enter a healthcare system that mitigates against inclusion of families due to time (see what it’s like to care for four or more patients per hour), diagnoses and healthcare reimbursement. If that were my professional background, my professional culture, I would run the other way when I saw a complex, demanding, needy family coming my way, as well.

I was a residency educator for almost twenty years. Early in my tenure I learned that I was a visitor in a different culture and, as such, I needed to enter that culture with respect and an eye to learning as much as I could to be of value. At first I thought I needed to convert the heathens to a family systems paradigm. If they could only become like me! Soon I realized that that wasn’t what was needed. More than anything else, residents needed help with their most difficult patients. As a family systems professional, my help with challenging patients often (but not always) included involvement of the family as a resource to the resident or as an important source for understanding the patient’s problems. Once residents saw that family could be integral to care and that involving family in challenging patient situations made their lives easier, residents often caught the family system’s bug. For me the lesson was---Don’t preach family-systems, just do it. Making it work in the exam room is the best evidenced-based example you can provide.

The challenge for family-oriented residency educators is to be comfortable and creative taking a one down position (yes, even after all these years!) in a system that is slow to accept differences, let alone change. That means wielding power and influence differently, if, at times, not equally. Becoming a recalcitrant adolescent ourselves is not the answer. Instead, we must recognize that as a maturing member of the medical education family, family-oriented healthcare educators must demonstrate the capacity to be systems-oriented in our clinical, research, educational, administrative and policy-making endeavors. We must leave "evidence” of who we are everywhere we go. I think that the better angels of Dr. Jacobs’ nature recognize this.


Barry Jacobs
Dave Seaburn
Barry Jacobs and Dave Seaburn are family medicine educators and long-term collaborators. Barry is the Director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency in Springfield, PA and the author of The Emotional Survival Guide for Caregivers—Looking After Yourself and Your Family While Helping an Aging Parent. Dave recently retired from a distinguished career as the behavioral science faculty in the University of Rochester Family Medicine Residency and has taken to writing novels, including Charlie No Face.

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Hello World! Are there opportunities out there for us, MedFTs?

Posted By Tania Riosvelasco, Tuesday, February 28, 2012
Before our very eyes, the world of Medical Family Therapy is growing, extending its reach to the far corners of the country, patiently and steadily solidifying its foundation as a cornerstone of what an exceptional & enriching healthcare service should be. The more I learn about MedFT, the more I feel compelled to get involved in it. While there are a lot of opportunities to do that within the US (it is after all, the birth place of Medical Family Therapy), they are lacking abroad. As a self-described ‘international MFT’, seeking to practice outside the United States, I’m left wondering, "What opportunities exist abroad for those of us who want to work in the field of medical family therapy?”

My personal experience with Medical Family Therapy, although relatively short, has been very enriching and is deeply rooted in my own life. Coming from a medical family I had a lot of insight into the medical world and developed an interest in the medical profession early on (I tried medical school in Mexico, but decided that I was better off without a scalpel in my hand!). I followed the mental health route and had no doubts when choosing an MFT program with an emphasis in Medical Family Therapy. And when it was time to choose a practicum site, I immediately focused my efforts on getting into the only collaborative care program, offered at UCSD Family Medicine.

Through my practicum year and my time afterwards as an intern, I gained invaluable knowledge of the medical world & how it intersects with the world of family therapy. How a family medicine clinic operates, the busy and unpredictable schedule of physicians, the myriad of health problems that patients present with, the prevalence of mental illness, and how family & social dynamics can positively or negatively impact patients’ health and motivation to adhere to their treatment regimen.
Tania Riosvelasco

"Individually we are one drop.

Together, we are an ocean.”

~Ryunosuke Sator

Throughout all of this, the most valuable lesson I learned was the importance of being able to collaborate and work as a team with other healthcare providers to seek and ensure the best quality of service for a patient.

The seed of Medical Family Therapy has planted deep roots in me and recently relocating to Germany, I seek to find opportunities to practice and continue my growth within the field of medical family therapy.

I also learned, while presenting at the IFTA 2011 conference in Amsterdam, about several programs in Europe where mental health clinicians are seeking to incorporate psychotherapy services, specifically family therapy, into hospitals (Norway). And about two specific projects: one where family therapy is being incorporated into a clinic specializing in obsessive compulsive disorders (The Netherlands), and another in a clinic where mental health treatment alongside family therapy is required by law (Germany).

Talking to the presenters, I got a general sense of the challenges of trying to incorporate collaborative & integrative care in Europe, as the field of family therapy is still struggling to make a stance, and the field of medical family therapy is small. In Germany for example, insurance will not cover family therapy services, so for psychotherapists trained under MFT models it is a challenge to pursue a career only providing psychotherapy services within a family therapy perspective and building a self-paying client base.

So it can be a little scary, to go out of the comfort zone that I feel the US provides, where medical family therapy is seemingly everywhere! Just take a look around the CFHA (and Google) and you’ll find a network of colleagues, research, information & links invested in furthering this field. But if we step outside these boundaries, what is there abroad?

Recently, the CFHA started an international sub-committee headed by AJ Jayabarathan (Canada) with colleagues from Spain, Hong Kong & Germany, which will seek to expand the reach of medical family therapy on a global scale. I hope this helps create opportunities for international family therapists & other mental health providers that want to continue working in this field. Although I don’t mean to imply that the field of MedFT is non-existent outside the US, it does seem to be lagging, and I think there should be more involvement and interest in creating and strengthening a global network to ensure that the advances made within the US are shared and implemented on an international level as well.

For colleagues out there, how have you done it? Are there opportunities for MedFTs on the global field? Or did you have to create them? Let’s share & grow!


A few links:

International Society of Behavioral Medicine (http://www.isbm.info/)

European Family Therapy Association (http://www.europeanfamilytherapy.eu/)

International Family Therapy Association (http://www.ifta-congress.org/)

The German Association for Systemic Therapy, Counseling, & Family Therapy (http://dgsf.org/)

Asociación Mexicana de Terapia Familiar (http://www.amtf.com.mx/)

Instituto de la Familia A.C. (http://www.ifac.edu.mx/)


Tania Riosvelasco, from Mexico, received her Master’s in MFT from the University of San Diego and worked as an intern at the Family Medicine Division of the University of California at San Diego. She has recently relocated to Germany and seeks to continue working in the field of MedFT. She also works as a translator (English-Spanish) specializing in psychotherapy & mental health translations.

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Adult Eating Disorders, Primary Care, and the MedFT

Posted By Lisa Zak-Hunter, Tuesday, February 21, 2012
Hmmmm…

During my faculty/resident lunch lecture on diagnosing and treating eating disorders (EDs) in primary care, I was asked the following question "I was wondering how well an appetite stimulant would work with someone who is restricting?” Heads around the room nod and there are a few approving looks toward the inquiring physician.

I affirm the suggestion: "Well, that seems to make sense. When I’m hungry, I look for something to eat. So, if someone’s appetite was stimulated, wouldn’t that increase eating behaviors? Not necessarily with someone who has an ED. EDs aren’t generally about food. They involve complicated feelings about control, self-worth, body image, stress, anxiety, attachment concerns, and many others. Food restriction, purging, and binging all become vehicles of self expression. People who restrict are familiar with hunger pains. However, the hunger has come to represent different things. For some, it is a sign of success, for others it is an annoying side effect they have gotten used to or put up with, and to others it may indicate they are losing control. Increasing appetite would likely only serve to increase these feelings and could actually spiral someone further into the ED.”

I’m met with looks of surprise, confusion, and understanding. At this point there are 15 minutes left, and I’m beginning to wish I’d signed up to do the whole week’s worth of lunch seminars. I’m struck by how little education there is on EDs in primary care and the importance of increasing physician awareness.

Eating Disorders in Adulthood

The Canadian and United States’ Eating Disorder Awareness weeks both occur in February, making this an appropriate time to address adult EDs and the role of medical family therapists in helping to raise awareness within the healthcare community. Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder (currently being considered as a separate diagnosis for the DSM-V).

Although EDs are often considered adolescent concerns, within the past decade there has been a significant increase in the number of early to middle aged women presenting for treatment.* Many of them are coupled and/or have children. Some have developed their first ED as adults, and others have struggled for years and never sought help or have relapsed.

Eating Diorders aren’t generally about food. They involve complicated feelings about control, self-worth, body image, stress, anxiety, attachment concerns, and many others. Food restriction, purging, and binging all become vehicles of self expression.
The reasons for developing or exacerbating ED behaviors in midlife are varied: job stress/loss, increased social pressure to maintain youthful body image ideals, pregnancy and a desire to regain pre-partum figure, couple conflict, menopause, sexual intimacy issues, distancing from or loss of parents, conflict with children, etc.  Symptoms in adults can be more severe than in adolescents, increasing the need for immediate action. Without treatment, approximately 10% of women with anorexia will die within 10 years, making it one of the most lethal psychological disorders. The systemic impact of adult EDs uniquely affects partners, children, parents, employers, and healthcare systems- all of which are underprepared and undereducated to appropriately respond.

Eating Disorders and Primary Care

As with most psychosocial concerns, ED or body image concerns are often first presented to a primary care provider. Many do not have sufficient knowledge or resources to ask the right questions, run the right labs, or make the right referrals. During my lecture, the well-intentioned physicians were also surprised to learn that EDs can develop at any age and that there has been an increase in adult diagnoses. With the increased focus on obesity, primary care providers often do not suspect or understand pathogenic weight control-especially in adults. Lack of understanding EDs in general complicates obtaining appropriate and immediate care for suffering adults. Based on the statistics I mentioned above, if a woman has already suffered for 10+ years without treatment prior to presenting to her primary care provider, time is of the essence. Enter the MedFT.

Working With and Educating The Physician

Many MedFTs are integrated to some degree within a larger healthcare practice such as a residency training program, medical center, or hospital. They are in a prime position to educate others, treat adult EDs from a systemic perspective, and offer collaborative care. The MedFT can improve patient care by facilitating communication between patient and provider, inform the provider if a patient has an ED and discuss how to address this in treatment, suggest what types of labs to run to monitor physical well-being, offer to run a lecture/discussion or grand rounds about diagnosing EDs in primary care, warning signs, and the importance of/how to discuss positive body image with patients- even adults.

They can encourage providers (and themselves) to inquire about current and past body image and dieting practices in their patients of all ages and discuss eating behaviors as a reaction to or coping mechanism for the presenting problem (if it is not an ED). A former colleague of mine (physician) contacted me after discussing weight management strategies with a new obese patient in her mid 40s. He wanted my opinion and further suggestions for how to handle the case. He had first explored the patient’s past dieting behaviors and exercise. He was surprised to learn the patient had a history of anorexia and became concerned about how to help the patient lose weight without triggering an ED. He decided the patient would need to attend counseling while on weight loss medication in case any ED behaviors resurfaced. The patient was unhappy with his decision, but I agreed with the physician. Proceeding in this manner could prevent a relapse and provided more responsive care.

Providing Treatment

Because of the systemic focus of their training, MedFTs can bring that perspective to consults with the provider and therapy sessions. Often, patients with EDs will deny or minimize the severity of the ED. Circular questioning is an excellent way to gather more relational information and assess severity (e.g., how would your partner say your eating practices affect your couple relationship? What would your children say you’ve taught them about food and body image?).

Lastly, the MedFT can increase collaborative care. The most effective ED treatment attends to the biopsychosocial-spiritual nature of the individual by combining individual, group, and family therapies, psychiatric care, nutrition counseling, weight and health management, and expressive therapies such as art, equine, or yoga therapy. MedFTs are well-trained in this theoretical perspective, so they can help coordinate communication among care providers and provide couple or family work (both of which are less commonly addressed in adult ED treatment). Not every family therapist may feel prepared to work with an ED and the patient may need more intense care such as a day program or in-patient therapy. Knowing local resources- especially those that are able to treat adult EDs- is key.

These ideas are meant to inspire, not serve as an exhaustive list of ways to increase consciousness or attend to adult EDs as a MedFT. Some are appropriate for working with adolescents as well. Overall, if you’ve walked away from this with a newfound awareness of adult EDs and a few ideas of how to address them with care providers in your practice, I’ve done my job.


ED resources for mental health professionals, physicians:

http://www.nationaleatingdisorders.org/information-resources/general-information.php

ED resources for patients, families/friends, others:

http://www.nationaleatingdisorders.org/information-resources/index.php

ED treatment referral sites:

http://www.something-fishy.org/treatmentfinder/

http://www.edreferral.com/

*Eating disorders are thought to affect approximately 1 million men and 10 million women in the US alone. Because of this disparity, there is less research on male eating disorders, especially in adulthood. Please note that my blog focuses on findings for adult women, simply due to lack of research on adult men.


Lisa Zak-Hunter, MS is a doctoral candidate specializing in family therapy at the University of Georgia. She is currently completing a behavioral medicine internship with the Department of Family Medicine and Community Health at the University of Minnesota. Her main clinical, teaching, and research interests lie in the realms of collaborative health care and increasing biopsychosocial understanding of mental and medical health conditions. She has a particular interest in adult eating disorders.

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Conversing about Conversation: What is MedFT?

Posted By Dan Marlowe, Tuesday, February 14, 2012
Since this is my first foray into the blog-o-sphere, I would like to start off by issuing a big THANK YOU (see, it’s big!) to Barry Jacobs, Jennifer Hodgson, and Randall Reitz for allowing me to help with and contribute to the Growing MedFT blog. Secondly, I want to give an even bigger THANK YOU to all of you who have posted, are willing to post, are contemplating about posting, and/or contemplating about contemplating about posting- your thoughts and ideas are incredibly important, appreciated, and essential to growing this "thing” that we are all passionate about. With that said, let’s dive right in….What is MedFT?

Now, before the hairs on the back of your neck stand-up and you ready yourself for an intellectual boxing match with the rest of my post, know that this has nothing do to with actually defining anything. It is my attempt to highlight the importance of our commitment to the on-going conversation about MedFT in general, how we have had that conversation so far, and why now more than ever, it is important for us to keep that conversation going.

What is MedFT? I remember being asked that daily in my doctoral program. In fact, my ability to accurately describe what it was that I was doing and my professional place in the world was a rather large part of my education- "doctoral” and "indoctrination” rhyme for a reason. Is it an approach, is it a sub-specialty, is it an orientation, is it an entirely new field, is it the answer to who actually shot JR (yes, I am old enough to remember Dallas)?
Dan Marlowe
What is MedFT?
In the end the most important part of that question (for me anyway) has little to do with the answer itself, but the conversations we have along the way in search of that answer.

These were questions that I struggled with and argued about for the better part of three years- even writing my competency manuscript on the subject. However, only after graduation did I realize that I had completely missed the most important part of those conversations/arguments.

What is MedFT? We have a lot of great descriptions of MedFT as a construct: we have the seminal work of Susan McDaniel, Jeri Hepworth, and Bill Doherty (1992), the work of John Rolland (1994), Linville, Hertlein, and Prouty-Lyness’s (2007) attempt to synthesize a description from the literature at that time, and even a Delphi study whose purpose was to provide a systematic description of MedFT through interviewing experts in the area (Tyndall et al., 2010). Let’s not leave out the other angles we have used to describe MedFT as well: we write about cases where we see it in play, we present models of care that purport to utilize it, we point to effectiveness research (not enough of it as Tai Mendenhall points out in an earlier blog post- check it out!), we even have specific training programs dedicated to MedFT and yet the conversation about exactly ‘what’ it is persists. I know I have left out a lot of examples here, but my point being that we have been trying to define MedFT for the better part of 20 years! So, should we just give up? Is the lack of consensus a tell-tale sign that our search for the ‘truth’ about MedFT, is ultimately as fruitless as counting how many licks it takes to get to the tootsie roll center of a tootsie pop?

What is MedFT? In the end the most important part of that question (for me anyway) has little to do with the answer itself, but the conversations we have along the way in search of that answer. The fact remains that what MedFT is or is not will be shaped by a number of forces beyond research, academics, and training (e.g., state/nation health policy, insurance companies, popular opinion, state laws), and even then what it becomes will always be up for negotiation- just look at how our own professional homes are in a constant state of flux. We attempt to define the nature of things (especially professions) by any all means necessary, we make laws, we research, we debate, we theorize, we practice; however, all of these things are impermanent, they are always changing, moving and evolving with those involved in their pursuit. In the end, what matters most is not that we ‘find’ the answer in that classical EUREKA!! moment, but that we are always ready and open to keep the conversation going about what that answer might look like if we ever came upon it.

In that vein of thought then: research, practice, develop models, post a blog (wink wink), or even have an old fashioned debate. All of these things embody the conversation about what MedFT is, what it is not, and what it can be. In the end, ladies and gentlemen, MedFT lives or dies on our words, thoughts, and actions in our pursuit of its practice and development. If MedFT is something we consider to be a passion, then the responsibility falls to all of us to keep that conversation going- if not us, then whom?

Now, remember at the beginning when I said I was not going to offer a definition of MedFT- I lied. Here is my stab, albeit a short one, at my understanding of what I do:

Before I start, I ask you to remember that the answer to a question is always bound by the way in which the question is asked. So, medical family therapy, for me, is the extension of an existing epistemology (there’s a 60 point Words With Friends word for you), or a way of thinking, into a specific venue or context (Marlowe, 2011). Now, the systemic/relational thinking indicative of MedFT is not isolated to a particular person or group of people, but it is, I argue, found as a rallying point in particular fields- and one of those fields would be family therapy (I know, I know- on the boxing gloves go). Now, I will be the first to tell you that not all family therapists think relationally, and that there are plenty of psychologists/social workers/physicians/nurses who are incredibly relational in their thinking and practice. However, I am not talking about individuals here (this is where I think we get stuck in these conversations); I am talking about fields of study and practice. As a field, family therapy was built on relational/systemic theory originating from biological, mathematical, and anthropological foundations. Even if we look back at Engel’s original 1977 article (admittedly not about family therapy), he quotes Margaret Meade, and utilizes the ideas of recursion, punctuation, context, frame of reference, and double description as foundations for his argument. It is important for me to point out that while I feel MedFT (as a profession) is indeed a sub-specialty of family therapy, it is not the same as its practice, or the patterns of thinking that define/inform that practice.

When we talk about medical family therapy, depending on the context, we are talking about it in three interlocking ways: as thinking, as practice, and as profession. Our practice of something does not mean that we belong to the profession that defines that practice- pulling a tooth does not make me a dentist. However, our allegiance to a profession, and subsequent practice of the techniques associated with it does not mean we align with its underlying way of thinking either- how many times have you said, "Wow, you don’t think/act like a physician.” My point being, that while practitioners might utilize the relational thinking and techniques associated with MedFT, as a profession, it finds its roots in the foundational epistemology of family therapy and the biopsychosocial model- a model that too attributes much of its roots to systems/cybernetic theory.


So, those are my thoughts. Now it’s your turn…..what is MedFT?


The search for the truth is more precious than its possession.

Albert Einstein


References:

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.

Linville, D., Hertlein, K. M., & Lyness, A. M. P. (2007). Medical family therapy: Reflecting on the necessity of collaborative healthcare research. Families, Systems, & Health, 25(1), 85-97.

Marlowe, D. (2011), Bridging Conversations: Discussing the Intra-professional Relationship between Medical Family Therapy and Family Therapy. Journal of Family Therapy. doi:10.1111/j.1467-6427.2011.00553.x

McDaniel, S. H., Hepworth, J., & Doherty, W. J. (1992). Medical family therapy: A biopsychosocial approach to families with health problems. New York, NY: Basic Books.

Rolland, J. S. (1994). Families, illness, and disability: An integrative treatment model. New York, NY: Basic Books.

Tyndall, L., Hodgson, J., Lamson, A., Knight, S., & White, M. (2010). The state of medical family therapy: A modified Delphi analysis. Unpublished doctoral dissertation, East Carolina University, Greenville.


Dan Marlowe is the co-editor of the Growing MedFT Blog, and the Director of Applied Psychosocial Medicine for the Duke/Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC. He obtained his MS in Marriage and Family Therapy and PhD in Medical Family Therapy from East Carolina University in Greenville, NC.


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Providing a Witness to the Experience of Our Colleagues

Posted By Lindsey Lawson, Wednesday, February 8, 2012

It has been so exciting to see the Growing MedFT blog take root over the last several months (Unbearably cheesy? Just go with it.)! Especially of interest to me are the stories of personal connection to Medical Family Therapy that the last several writers have shared... isn’t that what attracts many of us to this work in the first place? Understanding what people have been through and how this connects with who they are today? In her post on staying compassionate and open in a field where our tendency is to want to protect ourselves, Jackie questions whether or not we give enough attention to "recounting... health history and its impact on ourselves and our loved ones.” These illness narratives, as they are called, really matter.

I first began thinking about these issues before I went into the field of therapy, when I was working as a nurse at a small hospital in Oregon. During this time, my mom and brother were hit by a drunk driver in a collision that caused my mom to be permanently crippled in one foot. Our family reorganized completely, with me taking several weeks off of work to be with my mom while she underwent multiple reconstructive surgeries. What a strange feeling that was, to be on the other side of the healthcare system. We, the family, were essentially unnoticed by the medical teams and although our friends offered support (especially during those first few weeks), I remember feeling very much alone.

This is what illness does: It causes us to retreat inside of ourselves, believing that only we can tolerate the ugliness of our diseases and the darkness of our hopelessness. In her article "Witnessing, Wonder, and Hope” Kathy Weingarten (2000) writes of her life post-chemotherapy, "My life was bleak and lonely because I lived in silence, certain that no one could bear to hear the feelings and thoughts I had following my year of treatment; unwilling to find out if I was right; certain that I needed to protect people from my experience; and failing in those few times I tried to put into words the chaos of my emotions and the terror that lived in my flesh.” Lindsey Lawson
"Our ability to be witnesses to these experiences, to sit with physicians and nurses in their moments of pain, and to acknowledge what they have lost generates hope: the greatest gift that we can give."

Somehow we’ve come to see healthcare providers as being immune to these experiences. They are seen as the unaffected givers of care; not out of choice, but out of necessity. In our medical simulation lab at Loma Linda University, we have piloted a reflecting team approach to providing feedback to residents who work at creating compassionate ways of giving bad news to patients’ families. It has not been unusual to see the doctors and nurses fight back tears. Memories of their own losses surface and they reflect back on these as they review their reactions to the actors whose "family member” is dying. They report that no one has ever really taken notice or appreciated the care with which they try to face the implications of this all to frequent occurrence.

What is our job as Medical Family Therapists in all of this? To begin, we must start to address the intersection of healthcare professionals’ own experiences with illness and the burden of providing constant care to others. One of the physicians I work with says, "I just wish people would recognize that this isn’t easy... I go home some days and can hardly face coming back. No one seems to know that emotionally, this work is really difficult.” Addressing what is often un-recognized must be more than a passing thought for us; it is our responsibility. Our ability to be witnesses to these experiences, to sit with physicians and nurses in their moments of pain, and to acknowledge what they have lost generates hope: the greatest gift that we can give.


Lindsey Lawson is a second-year PhD MFT student at Loma Linda University and works at the Loma Linda Medical Center as a Medical Family Therapist. She has spent the last year working on a qualitative, grounded theory study in which she is interviewing nurses and nursing students about their personal experiences with illness and the way that these experiences impact their views of family-focused healthcare and wellness.

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What Brought Me Here?: Self-of-(Medical Family) Therapist Exploration

Posted By Jackie Williams Reade, Tuesday, January 31, 2012
Last week's Growing MedFT blog by StephanieTrudeau-Hern reinforced my sense that the self-of-therapist in the MedFT realm is an important conversation that we need to have more often. As a MedFT in pediatric palliative care, I am often asked about why I chose this field and how I can stay in a job where I daily encounter children and their families struggling with life-and-death issues. My reason for entering the field is clear as I was profoundly impacted by witnessing my paternal grandfather dying of pancreatic cancer while I was in college. For me, it was a lived experience in how consuming and lonely the illness and death of a loved one can be and that experience became the foundation of my career as I now seek to help others navigate their own illness.

As to my reason for how I can stay in this job? Not just stay physically in the job, but rather stay compassionate, open, able to think outside of my own grief and assist where needed, and maintain capacity to love and grow in my personal life is the more difficult question to answer. I find a common response to how to stay in this kind of job is to disconnect, distance, and protect yourself. While part of me agrees that these ways of coping are needed at times, I think the more effective way to work in challenging healthcare settings is to do the opposite, which is: connect, get closer, and be vulnerable with yourself in terms of how these experiences are affecting you.

To be compassionately present to the suffering of patients, their family members, and the healthcare team members we work with we need to understand our experiences of suffering, illness, and the healthcare system. We need to pay attention to what happens when we’re suffering, afraid, angry, or feel out of control - what happens in our body and mind - so we aren’t unconsciously causing harm to the healing process of another or ourselves.   While personal healthcare
"What brought me here?” is a good question to ask ourselves when we find we are stifled, overwhelmed, numb, scared, or angry as we interact with a patient, family member, or healthcare team member.
 experiences (good and bad) of ourselves, loved ones, and individuals with whom we work can be our most powerful generators of passion, empathy, and resilience, they can also be the first things that get in our way when we are working in the healthcare system.

While many of us spend months in Master’s programs discussing our assumptions, biases, and family of origin issues as they relate to our typical family therapy cases, I find we do not give the same quality or quantity of time to discussing these same concepts in terms of how they relate to working in healthcare. Do we recount the health history and its impact on ourselves and our loved ones? Do we discuss our reactions to the power dynamics and hierarchy that is often found in the medical setting? Are we exploring our own feelings of burnout, vicarious trauma, and compassion fatigue with safe colleagues and mentors? Being a MedFT is not just applying my skills in the medical setting, but rather it requires learning an entirely new system that requires re-evaluation of our beliefs and values as we sit with patients and caregivers who are often suffering in each area of the biopsychosocial-spiritual framework. Not to mention our attunement to our colleagues who are experiencing their own suffering. As MedFTs it can be an overwhelming challenge to assimilate all of these experiences.

I have now been working in pediatric palliative care and pediatric oncology for the past 15 years and the first 5 years were the most difficult by far as I struggled to make sense of the tragedy of childhood cancer and figure out my own dance (as Stephanie so eloquently refers to it) of engaging, distancing, crying, yelling, coping, and building my capacity for the significant burden of the work. I have read many books along the way that have helped me with some of this exploration, but a recent read I want to recommend to you is: "Beliefs” by Lorraine M. Wright, Wendy L. Watson, and Janice M. Bell. It is a wonderful resource to continue your thinking about the power of illness experiences and their impact on our beliefs and those of our clients.

"What brought me here?” is a good question to ask ourselves when we find we are stifled, overwhelmed, numb, scared, or angry as we interact with a patient, family member, or healthcare team member. Examining the events in our lives that are influencing our responses in the healthcare context is worthwhile work. While it’s not fair to assume we won’t ever be afraid, angry, or vying to control the outcome when faced with a situation that is challenging, what we can do is explore and recognize those experiences that impact our clinical capacity in the healthcare arena and continue our self-of-(medical family)-therapist work.

So… What brought you here? Why are you a Medical Family Therapist and how has that shaped your current practice?


Jackie Williams Reade, PhD is a Postdoctoral Fellow at Johns Hopkins University in Baltimore, MD. She received her Master’s in MFT from Seattle Pacific University and her PhD in Medical Family Therapy at East Carolina University. She is also the administrator of the Medical Family Therapy Group on Facebook.



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CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.