The Case for Primary Care Therapists

Stigma continues to be a serious problem in mental health, and anxiety about what it means to have a therapist can be a huge barrier to someone seeking services. Although we all have different life experiences and many people do not experience mental illness as defined by the DSM-5, every single person alive has an experience that is the worst thing they have ever been through. We need to normalize asking for and receiving help.

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Over the past four years that I have practiced as a clinical psychologist, I have had a number of clients reach their treatment goals and “graduate” from therapy. A number of these have asked, instead of terminating therapy completely, to continue to touch base with me on occasion, ranging from once a month to a couple of times per year. These appointments typically consist of checking in on symptoms, getting updates on any big changes in their life, and seeing what their needs are. Occasionally, I get a call in between these appointments because the client is struggling and needs to come in sooner.

I would argue that everyone ought to have a “primary care therapist” in the same way that we have primary care physicians: you don’t necessarily make regular appointments, but you know who you would call if you experience symptoms, and you check in a few times a year whether you need to or not.

Of course, there is the ongoing issue of accessibility for people who are low-income, uninsured, or living in rural areas. Telehealth helps with accessibility to an extent but does not completely solve the problem. There is also the issue that, in many parts of the United States at least, there are not currently enough licensed mental health professionals to meet the need, which is something that was discussed at the American Psychological Association 2020 convention.

But imagine if the question, “Do you have a therapist?” had the same answer as, “Do you have a primary physician?” It would not be unfamiliar or strange to make an appointment with a therapist because everyone does it!

I understand that this is not something that could be rolled out tomorrow, but I think re-conceptualizing mental health as something that everyone seeks out and actively works on throughout their lifespan would be a huge step toward eliminating stigma.

Published by Amy Marschall, Psy.D.

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. Her clinical interests are varied and include child and adolescent therapy, TF-CBT, rural psychology, telemental health, sexual and domestic violence, psychological assessment, and mental illness prevention. Dr. Marschall presently works in the Child and Adolescent Therapy Clinic at Sioux Falls Psychological Services in Sioux Falls, South Dakota, where she provides individual and family therapy and psychological assessment to children, adolescents, and college students. She also facilitates an art therapy group for adolescents and college students with anxiety and depression. Dr. Amy Marschall is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health.

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