Though it was just 14 minutes into the therapy session, and Greta had only seen him a few times, Bishop tried his best to interpret the daughter’s feelings. “There’s a period developmentally where we kind of look and go, ‘Gosh, I wish mom and dad were this way,’” he explained. Later, in their 30s, people realize their parents “are what they are,” he added.
“So this is her struggle, not your struggle,” Bishop told Greta, reassuringly. He wrapped up with some practical tips, urging Greta to compartmentalize her work and life issues, perhaps by journaling or taking a different route home from work.
Greta seemed genuinely pleased as Bishop swept out of the exam room. Her therapy session had lasted just 20 minutes.
Two weeks prior, Greta had walked into the clinic, a family-medicine practice situated on the campus of East Tennessee State University, hoping to see a primary-care doctor because she was so stressed she could barely function. When the receptionist initially told her, because of a miscommunication, that it would take a month to be seen, Greta cried, “I’ll be dead by then!” She was seen that day. After a medical resident finished evaluating her physically, he called in Bishop, the psychotherapist.
Bishop is part of a unique new breed of psychologists who plant themselves directly in medical offices. In clinics like ETSU’s, the therapists eschew the familiar couch-and-office setup. Instead, they pop right into in-progress medical appointments and deliver a few minutes of blitz psychotherapy. (ETSU allowed me to visit the clinic and sit in on patient visits as long as I did not disclose their real names or identifying details.)
Exploring one’s demons by the 50-minute hour might be a relatively common practice in large cities, but ETSU’s clinic is situated in the thick of Appalachia, where mental-health care is both less familiar and less accessible. Johnson City has recently witnessed an economic revival, with its brewery scene a modest tourism draw, but the surrounding region is still dotted with discount stores and unpainted shacks. Bishop’s patients bring him stories not only of family and marital strife, but also of financial pressures. If the trope is that psychologists help the “worried well,” this clinic helps the worn-out but hanging-in.
Also stationed in the clinic’s busy atrium that day was Jodi Polaha, a fellow psychologist, ETSU professor, and evangelist for this kind of therapy, which is called “integrated behavioral health care.” Along with providing therapy to patients, the clinic’s psychologists help train the clinic’s medical residents to employ their therapy techniques, which emphasize finding solutions. Some of the most common issues that send people to their primary-care doctors—like bellyaches and backaches—often don’t have clear physical causes. “It’s usually some lifestyle change that’s needed,” Polaha said. “That’s where we come in.”