Interview With William B. Gunn, Jr. About The Collaborative Psychotherapist

Interviewer [female voice]: Regarding your book, The Collaborative Psychotherapist, could you explain what you mean by a collaborative model of mental health care?

William B. Gunn: The idea of collaboration goes in a couple different directions. One is the collaboration between therapists and mental health providers and medical providers; but also between therapists and those medical providers and patients and families. So the collaboration is around creating relationships in all those directions that work, coming up with joint treatment plans, with having mutual respect between disciplines to provide the best care for patients and families.

Interviewer: How much of this kind of collaboration currently takes place between physical and mental health care providers?

William B. Gunn: It's dramatically increasing over the last five years. I've been working in this area for 25 years, mostly in the teaching setting, and most of the time, and still, the mind and body and the systems that sort of work with them operate in silos. But increasingly, probably driven a lot by health care reform and by just what makes sense to people of having their care provided comprehensively in the same place — in their "medical home" — you hear that term a lot — that it's increasingly happening in more settings as they come together in systems and look towards health care reform.

Interviewer: What types of patients do you see who you would normally not see in a traditional mental health setting?

William B. Gunn: It's what makes it interesting to work in this kind of a setting because there are people that I would not see. Geriatric patients who would not really think about going to a mental health professional — behavioral health is what we tend to call it these days in medical settings — but if their doctor says, "Would you go in for a stress consultation or a family stress consultation with this nice young man that works here in our center, would you do that?" And most people would say, "Sure." And so once they come in and realize it's not a demeaning or a stigmatizing experience, and they actually benefit from it, they'll do it again.

Another group is around people who somaticize their emotional distress. They're not going to go to a mental health professional for obvious reasons. They're coming to their doctor to say, "It's my head that hurts; it's my stomach that hurts; it's a chronic pain that's driving me crazy." And the physicians are sort of at their wit's end to be able to know how to work with these settings when they know that there are a lot of stressful factors that are at play at this. So, adding a behavioral health person to the team — not referring them away off to somewhere, but adding another person to the team — makes a lot of sense in those situations as well.

Interviewer: What advice would you give to an established therapist who'd like to take small steps toward working more closely with their client's physician and other medical professionals?

William B. Gunn: Probably the main reason that we wrote this book is that we were convinced that there are mental health providers out providing independent service in communities that would be really interested in working in this kind of collaborative way with physicians but weren't sure how to start. So, this was sort of a how-to practical guide.

And the first step is really an attitudinal change. Saying "I provide a lot of value to the clients, to the patients that I work with, but I could be a lot more valuable if I work in partnership with their primary care doctor, with their medical team." So just an attitudinal change in that way is the first start. Which is easier said than done sometimes when we get sort of locked into our own offices.

And then from there, there are a number of things that we outline around trying to create a toolkit involving forms that you could send to physicians, introducing yourself. And we have templates of those in the book that you could look at once you get a referral — what you could send to the physicians, ways that you could communicate with them.

And then to follow up with physicians. Often people will say, "I called them and they never called me back." The truth is that physicians aren't used to responding back. They get reports all the time from all kinds of specialists and they don't expect to call back. But if you make an effort to go in, to meet them, to meet their staff — the staff is critically important to things working. You call up, you're not going to get the medical provider; you're going to get the nurse. And if they know you and you say, "I'd like to talk to them," they'll pull them out of a room. They're used to doing that, and you could have a brief conversation around some kind of joint effort with the patients and families.

Interviewer: Is this kind of work a viable career option for recent graduates in clinical or health psychology?

William B. Gunn: Absolutely. And we're working very hard to try to create those kinds of environments. Right now, in psychology, in family therapy, in social work training programs, they don't provide course work and working in primary care and medical settings for the most part. So we're trying to create those kind of practical experiences that they can have.

I've been doing this ten years now with students coming in — psychology, social work, family therapy — it tends to not matter what guild. It tends to much more matter what kind of attitude they have in terms of working in this kind of setting. Because it is different and it can feel different. The language is different, the pace is different.

But once they get in and they get excited about it, they're starting to get jobs — as public and private health care settings start to look for, how can we provide more comprehensive care? How can we have a behavioral health provider that'll help us be more effective? And I can guarantee you, physicians who have behavioral health providers in their offices or have easy access to refer them to are much happier campers because they feel like they're part of a team.