Grand Rounds

I have been building a training program for marriage and family therapists who work with people in medical settings. There is a national trend to include mental health providers alongside physicians in clinics, hospitals, and follow up areas where medical patients are seen. This type of collaboration is still fairly new, but research shows that it pays for itself in reduction of unnecessary physician visits and waste of healthcare dollars. At a time when healthcare is a huge debate, it seems important to try to find ways to stretch these monies. Medical family therapy is one such way.

There are now at least four universities nationwide who teach medical family therapy, one offering a doctoral degree in it. In 2001, the former chair of the department called me in Minnesota and asked if I would be willing to come to this university and head up a new medical family therapy program. In fact, I'd never been trained in it and was unprepared to do that, so I declined. My dissertation wasn't yet completed--another reason not to come out to California.

Little did I know that in 2008 I would be placed in the role to fill a vacancy of the woman hired to do this job. Over time this program has grown and through the grace of God, I have been able to set up a sexual dysfunction clinic (physician, physical therapist and medical family therapy intern). I have placed three students in the hospital where they work alongside the psychiatry residents, doing bedside individual, couple, and family therapy, and also with rehab patients. They negotiate issues between volatile couples whose children are dying, assist contentious family members come to decisions about whether or not to withdraw life support, and work with those who are depressed, anxious, or otherwise emotionally compromised.

I have two interns seeing liver/pancreas and kidney transplant candidates as they wait for organs and either get very sick, get an organ, or die. The stories they tell me each week are amazing--I do not know a more needed resource than family therapy for these folks. The stress on their families is beyond anything that I hope I will ever be called on to endure.

I've placed a student in the perinatal palliative care unit, working with high risk moms who recognize that when they give birth, their babies will die due to a number of pregnancy problems. This intern will also be making follow up home visits to try to help the parents negotiate and manage their (typically) very different grieving styles and needs.

Two interns are in our outreach primary care clinic, providing mental health services in exam rooms for the underserved in our region.

Last but not least, one student is now placed in the medical school simulation lab, working with medical students, residents, and specialty fellows, coaching them on death notification and general attending and communication skills.

All of these folks are practicing under the umbrella of my license and supervision (I pray a lot!)

It seems that my program is on the cusp of really taking off. Students are clamoring to get into it (it's just for doctoral students in our department), and physicians are now taking notice of how much improved their patients are after seeing our interns.

One of the things I've been doing is holding medical family therapy grand rounds once per month. Since my interns are largely from non-medical backgrounds, any exposure to medical equipment, language, or phenomena, are much appreciated. Last week we had a sort of medical tube petting zoo for my students. You can see here, that they really enjoyed working on the manikins in the simulation lab.

After they watched me insert a catheter in this manikin who supposedly had an abdominal incision ("eeeouw" all around), I asked them to get him up on a bedpan. It took the whole group several minutes to figure out how to accomplish this for the 250 lb. patient. It was a major production. Good thing it wasn't a real person trying to hold out!

What a lark! I am having more fun than I thought possible. But it has been all-consuming. This is why I haven't been online for almost a month. Thought you'd like to see what has been happening in my world.