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“… I normally see patients for 3-6 visits.”
“… we will focus on the symptoms that are getting in your way right now and help you to connect to something longer term if needed.”
“… I can help with x, y, and z but if you need help with a, b, and c we will find someone in the community to help.”
These are a few examples of how I have introduced myself to patients in the past. One of the many thought bubbles I took away from the 2020 CFHA conference was the idea that we behavioral health consultants (BHC) have the tendency to undersell the care we provide from the first moment we meet a patient.
I have done this hundreds of times. I have trained other BHCs to do it (facepalm). I am now in the process of recognizing that it does not serve patients or BHCs in the way I had hoped or understood that it would.
In my experience, this approach comes from a place of wanting to set expectations and place a container around work that in reality is endless—the internal work that is essential to human functioning.
The comparison to primary care providers (PCP) that several of the conference presenters shared was useful—when you go see your PCP for a problem, they talk with you about the problem, making recommendations and follow up plans. It is hard to imagine that a PCP would say “I can see you 3-6 times for this problem before I give up”.
What PCPs do sometimes discuss is that specialists (GI, endocrinology, gynecology, etc.) are required for certain problems and that part of their care may include a referral to a specialty provider. This is certainly also true for BHCs—we are generalists who are well-situated to discern and make recommendations for specialty mental health care (from ACT to EMDR to DBT) based on what we learn about the patient and their expressed goals along with what is available and accessible.
I have been trying on this approach for size. The amazing thing is that it has not changed the number of visits I complete with patients.
What has changed is manifold: the patient’s—and my own—expectations that the work we do together will be helpful; the amount of time we spend in intervention vs time consuming resource-seeking to connect to someone with the same skills that I possess; and the way I frame it when it becomes clear that specialty care will be helpful.
The complexity will not go away, and I am learning to embrace that. BHCs are on the front lines of the reality that our society and culture devalue the very things that stand a chance of easing the human experience: robust social supports that put the natural environment, racial and economic equity and educational opportunity above profit.
Our task is often to walk with other humans, bearing witness to this struggle and providing insights and strategies based in skilled listening. When we do our jobs well BHCs deal in human hearts; to imagine that we can distill that experience down to something as quantifiable as 3-6 visits is laughable. So, I have been trying on some new one-liners for size:
“…. I specialize in emotional well-being, can you tell me a little more about x, y, and z?”
“… if you can spend some time thinking about/trying x and come back to see me in a few weeks to tell me how that went that will really give an idea of how I can be most helpful to you.”
“… based on what you have shared with me about yourself I would like to spend our time today focusing on x, y, and z because I think you will find this useful.”
I suspect that I will continue to grapple with this for the rest of my career—and I am learning that accepting this is key to continuing to be of service. It will also likely continue to be the source of endless head-spinning.