Picture this: You’re training for your
first marathon; your family just
moved into a bigger house (the kids
love their new backyard); and you
finally got that promotion at the office.
Life seems, well, perfect. Then, crash.
You didn’t see that car cross into your
lane. You’re alive, but the accident has left
you with chronic pain. You spend the next
months in and out of treatment centers.
Nurses, doctors, and physical therapists swirl
around you like worker bees repairing a hive.
But they don’t seem to be communicating with
each other, and the pain in your body is now
causing pain in your mind.
Depressed? I’m not crazy, you tell yourself.
But a voice inside is crying out for help. Focused on
your physical prognosis, your doctors don’t seem
to be concerned that you’ve lost your job and that you
may lose the house, too; that your spouse hardly smiles
anymore; that your kids’ grades are plummeting. And
suddenly, while your body is getting first-class treatment,
your mind and spirit are about to signal a code red. Enter collaborative care.
It’s a relatively new trend in medicine based
on the principle that body and mind are intertwined and should be
treated as such — holistically. Specifically, collaborative care suggests
that health care providers of all kinds should work together to
meet the full range of a patients’ needs. The movement is gaining
momentum across the nation, from universities such as Seattle
Pacific to top medical centers and national policymakers.
Last year, the Collaborative Family Healthcare Association
(CFHA), in concert with the American Psychological Association
(APA), launched the Health Care for the Whole Person
Task Force. APA President Ronald Levant has stated, “One core
assumption that requires rethinking is the idea of the separation
of mind from body … that there are some illnesses that are
physical and others that are mental.” By assuming such separation,
Levant explains, we have created a dysfunctional health care
system: “As we all know, mind and body are not separate, but
rather they are inseparable.” The CFHA takes this concept a step
further, affirming the “patient, family, community, and provider
systems as equal participants in the health care process.”
Adds Levant, “We need to transform our biomedical health
care system to one based on the biopsychosocial model, which
will emphasize collaboration between medical and behavioral
health care providers, and the integration of psychology into the
very heart of heath care.”
These ideas are ones that Seattle Pacific has long embraced.
The three elements of the biopsychosocial model — bio (physical), psycho (mental), and social (relational) — make up the
foundation for the academic program in SPU’s School of Psychology,
Family, and Community (SPFC). What is unique,
however, to SPFC is the fourth principle it embraces: the spiritual.
“Luke 2:52 says, ‘Jesus grew in wisdom, stature, and favor
with God’ — that’s our model for biopsychosocial-spiritual care,”
says Claudia Grauf-Grounds, chair of the Marriage and Family
Therapy program. “It’s not about compartmentalizing faith; it’s
about letting faith be an instrument of healing.”
Seattle Pacific’s Medical Family Therapy (MDFT) certificate
program, one of only eight such programs in the nation, trains
marriage and family therapists and other psychosocial providers to
work in outpatient clinical settings alongside physicians. “We are the only program that has a spirituality component as part of
our core training,” says MDFT Director Tina Schermer Sellers.
As she launched the program in 2000, Sellers drew on her
professional experience working with cancer patients. When the
patients wanted to talk about issues of faith, she noticed that some
of her colleagues were reluctant and unprepared for such dialogue.
“Patients want to have these kinds of conversations,” she says.
“That’s why we prepare SPU students to be ready.”
It’s the kind of care that considers the mind, body, spirit, and
relationships, explains Sellers, that makes a difference in the lives
of patients: “When people deal with chronic illness, all aspects of
their lives are affected. Current treatment models just don’t deal
with the depth and complexity of what patients and their families
A major roadblock to collaborative care is the “this-is-theway-we’ve-always-done-it” mentality. Medical schools don’t often
train their students to engage in conversations about patients’
psychological or spiritual concerns, yet family practice clinics are
typical places where depression and other mental illnesses present
themselves. “A large accumulation of research says that the
way we’re currently treating patients is ineffective,” says Sellers.
She and Grauf-Grounds believe that collaborative care can
bridge the gap. Both worked to bring the national Collaborative
Family Healthcare Association Conference to Seattle last year and
organized a groundbreaking pre-conference event, the Northwest
Health Care Summit, which assembled health care leaders such as
hospital and insurance company CEOs, legislators, and policymakers
to discuss issues related to collaborative care. “There is more
readiness for change than I’ve ever seen,” says Sellers, also noting a
recent parity law passed in Washington state that levels the playing
field between physical and mental health insurance coverage.
For Sellers, the momentum provides hope for the future of
collaborative health care: “In 10 years, I believe you’ll be able to gophysito
the doctor’s office and also be treated by a psychosocial provider.
The family, as well as the individual patient, will become the unit
In the meantime, she, Grauf-Grounds, and others at SPU are
hard at work training students to understand how life stress and
illness can affect the mental health of patients and their families.
Bringing her clinical experience to the classroom, Sellers often
relates experiences from the Northwest Cancer Resource Center,
where she worked alongside oncologists treating breast cancer
patients. After prepping patients for the inevitable — chemotherapy
and the accompanying hair loss and nausea — she
helped them with emotional and relational issues as well.
“So often women assume that breast cancer has made them
undesirable, and they think their husbands find them unattractive,”
she says. But when Sellers encouraged patients to invite
their husbands to therapy sessions, she helped the couples discuss
their fears. “I found that the men were less physically intimate
with their wives because they were afraid of hurting them,”
she says. “I got them talking about what they were afraid to say,
and before long I’d see the husbands break down and tell their
wives, ‘I don’t care if you don’t have breasts. I just love you so
much, and want you to be OK.’”
“In medicine, it’s so easy to simply focus on the patients, but
so much of what they’re dealing with involves families and relationships,”
adds Grauf-Grounds. As part of a patient’s treatment,
medical family therapists sometimes bring the entire family
together to discuss how the person’s illness affects each family
member. In one of her therapy sessions, Sellers encouraged a
woman and her family to document her breast cancer experience
in a scrapbook. Instead of bottling up their emotions, the children
drew pictures of their mother with a bald head, and the
scrapbook helped in the healing process.
While collaborative care sounds like a great idea to many
physicians and clinicians, there are still obstacles. Many have
practical concerns. “They worry that co-locating a behavioral specialist
in their practice will be difficult and expensive,” explains
Sellers. But placing Seattle Pacific medical family therapy interns
in clinics can make it easier for doctors and psychotherapists to
embrace the idea of collaborative care. Says Sellers, “Once doctors
experience this way of working, and see the benefits to their
patients, they never want to go back.”
—By Sarah Jio
— PHOTOS BY Mike Siegel
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