5 minute read

“Welcome to day one of your integrated care practicum. The first step you’ll take is to purchase two books and begin reading them right away. OK, let’s talk about Centricity!”

Fall semester of 2009. I am a new student in the Medical Family Therapy doctoral program at East Carolina University (ECU). My new supervisor, Dr. Jennifer Hodgson, has just instructed me to purchase “Models of collaboration: A guide for mental health professionals working with health care practitioners” and “Behavioral consultation and primary care: A guide to integrating services”.

Dr. Hodgson’s office was in the ECU Family Medicine Center, adjacent to the patient waiting room and front desk. I can close my eyes and still picture the waiting room. The building was replaced two years later with a larger and shinier facility that was less amenable to integration.

“Models of Collaboration” arrived at my apartment within a week. The jacket design included a white stripe between two layers of pistachio green. I read the book twice during my studies. Seaburn, Lorenz, Gunn, Gawinski, and Mauksch taught me how to work alongside primary care providers using numerous vignettes and practical suggestions.

“Behavioral Consultation and Primary Care” arrived at the same time. The front cover seemed inspired by Jimi Hendrix with a deep purple hue and heat signatures from collaborating professionals. I read the book multiple times, eventually breaking the spine. I pored over the handouts and protocols while treatment planning for my own patients. Robinson and Reiter taught me how to be a behavioral health consultant.

“When you are not seeing patients, I want you sitting in the preceptor room listening to the residents present their cases. You should offer behavioral health services when appropriate.”

The preceptor room was busy with residents coming and going. The space was filled with tables and chairs, like a castaway cove of office furniture. I learned so much sitting there, listening to residents present their cases while I pretended to read my books. The supervision style was so different from the armchair locution of psychotherapy training.

Integration at the family medicine center was collocated and mostly collaborative. All my referrals came from the medical clinicians. I had access to the shared electronic health record, including diagnoses, prescriptions, procedures, encounter notes, and referrals. To a new psychotherapist like me, each patient record was a medical treatise documenting their ailments and treatment journey. The patient record was like a second instructor to me.

My psychotherapy sessions at the family medicine center were 60-minute sessions, a familiar cadence. During supervision, I learned how to focus on physical health symptoms, illness journeys, relationships with providers, and care coordination. I attempted to use a biopsychosocial lens when conceptualizing each patient case. I should have engaged more with the medical clinicians, sharing my insight and treatment planning together.

I grew professionally and personally during this clinical placement. Prior to this training, I spent little time in medical offices as a patient or professional. I was intimidated by nurses and physicians because I did not understand their training, perspective, or culture. That intimidation kept me from developing closer working relationships early in my training.

I was also living in a new state as a newlywed husband and new doctoral student. When asked about my clinical training or doctoral program, I sometimes struggled to explain integrated care or medical family therapy to my friends, neighbors, and family members. I sometimes wondered how I had wandered into this strange, new field of integrated care.

Professionally, it took time for me to orient from a mental healthcare culture to a primary care culture. During my masters-level training in family therapy, I became accustomed to quiet hallways, white-noise sound machines, and two-way mirrors. I did not immediately understand the mission and culture of primary care. It was busy and information intensive. Over time, I began to enjoy the hustle and bustle and challenges of the family medicine center.

I entered the fields of medical family therapy and integrated care because of my curiosity. I stayed thanks to support from faculty, colleagues, and loved ones and my initial commitment to the doctoral program. My first clinical placement taught me to embrace the collaborative spirit, shifting from a solo act to team play. I developed interprofessional communication skills, expanded my clinical lens, and fell in love with primary care.

“That’s it for today’s supervision. Next week, each of you should be prepared to discuss what Seaburn says is the foundation of collaboration and why Robinson and Reiter believe behavioral consultation supports the mission of primary care. See you in a week!”