May/June 2007

Exploring Collaborative Health Care

By Rich Simon

When even Republicans are earnestly discussing what to do about the "health care crisis" and corporate executives can utter the once-taboo words "universal health care" without reflexively crossing themselves as if warding off a vampire, you know something new is afoot in the American zeitgeist. It may not be too much to hope that, as a society, we're actually on the verge of overhauling our anachronistic and wildly overpriced health care system for something better. (Then again, we may not be—remember 1994 and "Harry and Louise," a fake couple in a TV ad paid for the insurance companies that helped destroy the Clinton health care plan?)

If this revolution does actually happen this time, it will not only transform the way medical care is paid for and who gets it (presumably everybody in America, by virtue of being human), but how it's organized and delivered. Instead of the fragmented medical care mishmash we now have, we're likely to see a far more integrated approach—what's been called a kind of one-stop-shopping health care system, which would combine physical, rehabilitative, and mental health care within a single, rationally organized, coherent, customer-friendly package. I always envision this system as something like the bar on the TV show Cheers—a friendly place where everybody (doctors, surgeons, physical therapists, nutritionists, psychotherapists) not only knows who you are, but just as important, knows and can work with all the other providers in the group. Instead of a bunch of rugged individualists, each doing his or her thing, they'll all be team players, and playing on your team.

What does all this have to do with psychotherapy? For most of our profession's history, we've been good, steady Cartesian dualists. In spite of the increased medicalization of psychiatric conditions represented by the DSM and the inroads of psychopharmacology, most of us still imagine that we take care of people's minds, while others (doctors, nurses, rehab people) take care of people's bodies. And never the twain shall meet, at least in our consulting rooms.

But the fact is—as the contributors to this issue are urgently pointing out—the line between body and mind, physical sickness and emotional dysfunction, is blurring to the point of invisibility. Unlike broken legs or acute appendicitis or pneumonia, many of the medical conditions increasingly afflicting our society tend not to be curable by a dose of antibiotic, an operation, or a cast. Such illnesses as diabetes, obesity, asthma, heart and vascular diseases, Alzheimer's, chronic pain, cancer, asthma, AIDs—the diseases of our time—aren't only chronic and debilitating, but often emotionally devastating, for the afflicted individuals and their spouses and families. Whether people cope with their medical problems well or badly is often a social and psychological issue, which can make the difference between recovery and decline, or even death.

So, if there was ever a role for psychotherapy, it would seem to be in collaborating with other health professionals in the world of what's now called biopsyschosocial medicine. As William Doherty suggests, our therapeutic skills give us a real advantage in the medical world. "We may start out ignorant about medical issues, but when it comes to interpersonal communication, the average therapist's skills are dazzling to many medical professionals." Are therapists ready to take the plunge? Not yet, says Doherty, but we can and should be. Getting up to speed on medical issues and taking part in the integrated health care of the future—on the front lines of the revolution—is where the therapeutic action is going to be. If we aren't prepared to join the vanguard, Doherty reminds us, we're likely to find ourselves and our profession straggling behind the times, without a place in the new integrated medical system that's emerging.

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