Part 1 of 2

Two LMFTs explore career choice through the lens of family-of-origin and a drive towards systems change. This series was inspired by a conversation in Raleigh at the end of Day 2 of the annual conference.

Jess & Chus

Is it fate? Destiny? A series of tiny nudges and moments?
Is it a whisper or a compulsion?
Something in between?

During a lively chat at CFHA, Chus and I, both LMFT’s, began to ponder just that. In Part 1 of this 2-part series, I reflect on my earliest roots leading me here.

I could trace my foray into integrated behavioral health to 2019—meeting members of the NH IDN Medicaid Waiver team, being encouraged to apply for funding to build an integrated program at Aloft, and then launching Aloft’s pediatric CoCM program in early 2020, mere weeks before the world shut down. Even in those early months, there was a sense of energy—something clicking into place. But if I tug on the roots of what led me there, the story goes much deeper.

As a Marriage and Family Therapist, I was trained to see systems: patterns, relationships, roles, feedback loops. LMFT training shaped me into someone who doesn’t just look at symptoms, but at constellations—families, communities, teams, organizations. It made me a puzzle piece that naturally fit into the ecosystem of integrated care. But even before graduate school, before the AAMFT Code of Ethics, before the supervising clinicians and genograms and practicum hours, there were earlier lessons—quiet ones, often whispered by the rhythms of family life.

Childhood as My First Classroom in Systems Theory

My father was a law enforcement officer who believed deeply in serving his community. The uniform meant something to him—not power or authority, but stewardship. As he moved up the ranks and eventually retired as Lieutenant, he took pride in mentoring younger officers, teaching professionalism and integrity. He treated people with humanity, even in the most difficult moments. 

When I was five, my dad was still a patrol officer—too low in rank to request Christmas morning off. My sister and I woke early to find our stockings full, but the bigger gifts would have to wait  until he could take a break to come home. I remember sitting at the window, watching for his cruiser to come down the street. No one complained—not him, not my mom. We simply waited, knowing that service sometimes requires sacrifice. When he finally arrived, we tore through gifts with the joy of children who didn’t yet understand the weight of the world but were already shaped by it.

Years later as a teen, my dad began driving the long way home when picking me up from basketball practice. Two to three times per week, we drove through a nearby neighborhood, past a house my dad was surveilling as part of a large drug smuggling investigation. Somehow he decided having a child in the car was the best cover. I was asked to memorize the make and model of cars in the driveway. We noticed patterns, timetables. This went on for months before the raid and arrest. At the time this felt normal to me; my dad doing his job. Looking back, I realize it was anything but normal.

My mom lived the value of giving back in her own quiet ways. She was my Girl Scout troop leader, and in one unforgettable example, an upcoming early summer camping trip was at risk of being canceled because the troop needed an adult with lifeguard certification. Instead of canceling, she and the other troop leader signed up for a two-day ocean-based lifeguard course… in May… in New England. I watched her come home wrapped in towels, exhausted and freezing, heading straight for a hot shower. She never complained. She just did what needed to be done so a group of young girls wouldn’t miss out on a formative experience.

Another year, with extra troop funds left over, my mom organized a dress-up dinner at a formal restaurant. Years later she told me she realized some of the girls came from homes where they weren’t learning formal manners—and she wanted every girl to grow up knowing how to carry herself confidently in important spaces. She knew that job interviews and significant life meetings sometimes happen over dinner, and she refused to let a lack of exposure limit any girl’s future. She didn’t preach empowerment; she modeled it.

No one ever told me to “give back to the community.” It was absorbed through observation. I was raised with the value of “leave it better than you found it”. Give back. 

Early Career

Years later, as an early career clinician, when I was working in community mental health, my dad asked whether I was seeing “bad stuff.” I laughed wearily: “Yes. A lot.” I told him about children in group homes or foster care, kids labeled “bad” for behaviors that made perfect sense given their trauma histories. He told me that the hardest part of his job had always been encountering children in unsafe homes. He confessed that sometimes he wanted to take them home with him. At minimum, he always bought them something to eat while they waited for social services—knowing full well they were stepping into another system with uneven quality.

My mom listened to our conversation, horrified by the stories. “You have to change it, Jesse,” she said. “Fix it.” At the time, her words frustrated me. The system felt too big, too entrenched. I didn’t yet understand that sometimes a mandate delivered with love is meant to plant a seed, not demand a timeline.

Years later, a similar conversation emerged—this time about mental health access and children being boarded in Emergency Departments during psychiatric crises, sometimes for days on end. Once again my mom said, “You have to change it. This isn’t okay.”

But by then, something in me had shifted. By then, I was working in integrated behavioral health—building CoCM programs, training care managers, training PCPs, addressing the structural barriers that prevent children and families from accessing timely, quality care.

And this time I replied, “I’m working on it.”

LMFT Training, Systems Thinking and Integrated Behavioral Health

To an LMFT, Integrated Behavioral Health is familiar, even intuitive terrain. The Collaborative Care Model applies systems theory to healthcare delivery. The patient doesn’t exist in isolation. The PCP doesn’t exist in isolation. The care manager, the psychiatrist, the EMR, the workflows, the policies—these are all members of a living system. Our job is to help them function in alignment; make the system stronger.

And there are no heroes here.  Integrated care is built off one another’s work. No single professional is the savior or the leader; the system heals when the team moves in synchrony.

Team-based care is our lineage, and our roots run deep

We have a long journey ahead in scaling integrated behavioral health, and I feel proud to contribute—even in a small way—to a movement that is reshaping how care is delivered. One person alone cannot change a system, but a community of people—like CFHA—can. Together, we slowly push the boulder uphill. We build off one another’s experiences, research, innovations, and connections. We elevate teams. We create career pathways. We build programs that outlast us.

We aim to leave it better than we found it.

Photo by Roman Kraft on Unsplash