Primary Care Therapists Will Change Our Field

Primary Care Therapist (PCT) is a new clinical role. It does not exist today, but our field will be fundamentally changed if it takes root and grows. This role is more than an amplification of existing primary care practices. Little change is likely if we continue placing clinicians in the primary care setting to do therapy. The PCT involves changing the institutions of primary care and behavioral healthcare.

Grand declarations about common things like psychotherapy can seem silly. Yet every transformation starts small. Consider how the timeless practice of exercise has dramatically changed over the past 50 years. Tens of millions of people work out vigorously today. Maybe 100,000 jogged years ago. We now have personal trainers, exercise physiologists, and a thriving fitness industry. Fitness is not a simple jog.

Change often begins by destroying old ways. PCTs will ideally emerge alongside a movement to erase stigma in our field. This anti-stigma focus is structural in nature, rather than educational, and the goal is to change behavioral healthcare as an isolated specialty. Stigma will disappear when everyone can get behavioral healthcare as part of primary care, thereby ending our history as mainly a specialty service.

These changes rightly start from patient-centered goals. While there are other important objectives, the priority is to help all healthcare consumers. In addition to making behavioral health disorders shame-free, we need to alter related social norms. Sadly, our society teaches us to shun emotional vulnerability and to avoid personal issues at the root of our health status. A new vision of health is needed.

There are other benefits from reconfiguring primary care with behavioral health as a core element. Therapists will have new career paths to follow, and behavioral executives will have new business opportunities to pursue. Higher levels of behavioral healthcare will benefit since PCTs will be able to identify problems earlier and make referrals for more timely stabilization of acute crises.

The PCT role will not appeal to every clinician. There are several defining elements of the role. The skills are not core to the training of most clinicians, but they leverage traditional skills from various disciplines. While many will enjoy this new work, skeptical clinicians should realize long-term treatment will always be needed for complex cases. These specialists may be fewer, but they will always be essential.

The first focus for the PCT will be the identification of psychological issues driving one’s health status. This occasionally relates to a DSM diagnosis since psychiatric disorders are one potential focus. Yet it is also common for our lives to be impacted by negative moods or traumatic events that do not meet diagnostic criteria. The search for a diagnosis is not primary. Ask, what is impairing functioning?

People are often unhealthy due to issues unrelated to psychopathology. The work of the PCT will be primarily focused on goals for behavior change. They are universal and non-pathological. The issues are often common, the stories personal. For example, many people eat poorly, move little, and ignore doctor’s orders. They need help, but MDs lack the tools to explore why and how people get stuck.

PCTs will not be providing psychotherapy. They will be leveraging their therapeutic skills to provide brief interventions. We could use help from our current “masters of psychotherapy.” They meet annually to discuss the evolution of psychotherapy. Our field might benefit more from having its innovative minds focus on tailoring therapeutic services for primary care, not just on perfecting psychotherapy itself.

The PCT will be a care coordinator. Many patients will need additional behavioral care outside of the primary care setting. This might entail directing people to digital therapeutic tools or local behavioral clinicians, or it could be connecting people with resilient peers and self-help communities. Given the frequency of medical disorders in primary care, similar social support is needed for medical issues.

PCTs will hopefully find themselves welcome in primary care given the crisis that has been escalating there for many years. PCTs can help fix many deficiencies in primary care today, but this cannot be their main motivation. Their priority will be bringing stigma to a permanent end by getting people connected with trusted, non-judgmental clinicians to discuss everyday emotional conflicts.

PCTs will fulfill one final role. They will shape a culture of behavior change in primary care. This has been missing for PCPs in their work with acute and chronic medical conditions. PCTs will not only change our field, but they will also change primary care. Every patient will get to focus on needed behavior change. Every patient will be able to routinely address their vulnerabilities and mental health.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.