When a person seeks counseling, they rarely arrive with only one isolated concern.
Anxiety may show up alongside sleep problems. Depression may exist alongside chronic pain, medication changes, grief, or a new medical diagnosis. Disordered eating may involve emotional distress, physical symptoms, shame, medical complications, and confusion about where to begin. Trauma may affect the nervous system, the body, relationships, and even the way a person understands their own health.
Yet for many people, care is still divided into separate boxes.
A primary care physician may manage medication, bloodwork, referrals, and physical symptoms. A counselor may help the client process emotions, trauma, behavior patterns, stress, relationships, and coping skills. Other professionals, such as dietitians, psychiatrists, physical therapists, occupational therapists, or specialists, may also be involved.
Each provider may be doing meaningful work. But if those providers never communicate, the client is left carrying the weight of coordination.
That is the problem my doctoral research set out to explore.
My dissertation, The Lived Experience of Private Practice Counselors Participating in Integrated Collaborative Continuums, examined how private practice counselors experience collaboration with primary care physicians. More specifically, I wanted to understand what happens when counselors in private practice step outside the traditional siloed model and participate in collaborative care, even when they are not located inside the same office, hospital, or medical system.
The findings were clear: collaboration is not always easy, simple, or financially supported. But counselors still overwhelmingly saw it as valuable. They viewed collaboration as part of client advocacy, part of holistic care, and part of a stronger professional identity.
The Problem With Siloed Care
Siloed care occurs when health care professionals work separately from one another, even when they are treating the same person.
In theory, this separation may seem organized. A physician handles medical concerns. A counselor handles mental health. A dietitian handles nutrition. A psychiatrist manages medication. Each professional has a scope of practice, and each stays in their lane.
In real life, people are not divided so neatly.
Mental health and physical health are deeply connected. Stress can affect sleep, appetite, digestion, pain, energy, immune function, and heart health. Medical conditions can increase anxiety, depression, grief, fear, and isolation. Medication changes can affect mood, motivation, and behavior. Trauma can live in the body, not just in memory.
When care is siloed, the client may be expected to explain the same story over and over again. They may need to remember what one provider said and repeat it accurately to another. They may have to advocate for referrals, ask follow-up questions, clarify medication side effects, or request communication between professionals.
That is a lot to ask of someone who may already be overwhelmed.
Siloed care can place the burden of coordination on the client, when in many cases, the client is the person least equipped to carry that responsibility alone. This is especially true when someone is experiencing anxiety, depression, trauma, grief, chronic illness, or a major life transition.
What Is Integrated Collaborative Care?
Integrated collaborative care is a model in which professionals communicate and coordinate care for the benefit of the client.
This does not always mean every provider works in the same building. It does not always mean shared records, shared billing, or a formal team meeting every week.
In private practice, collaboration can be much more informal. It may involve a counselor calling a primary care physician with the client’s written consent. It may include discussing medication concerns, sharing observations, supporting a referral, clarifying symptoms, or helping the client feel more confident speaking with their doctor.
The key idea is simple: professionals should not work in isolation when the client would benefit from coordinated care.
In my study, I focused on private practice counselors who were not embedded in a hospital or co-located medical office. These counselors were working independently or within private practices, yet they still made efforts to collaborate with primary care physicians.
That distinction matters.
Much of the existing research on integrated care focuses on hospitals, treatment centers, medical offices, or large systems where behavioral health providers are already part of the care structure. But private practice counselors are often outside those systems. They may not have access to shared records. They may not be paid for consultation time. They may not have an established process for reaching physicians.
Still, they collaborate.
And their reasons for doing so reveal something important about the future of mental health care.
Why This Study Was Needed
The counseling profession has continued to grow in identity, scope, and recognition. Counselors are trained to assess, diagnose, treat, support, advocate, and empower. They are also trained to understand people through a wellness-based and developmental lens.
Even so, the counselor’s role in collaborative health care is not always clearly defined.
Physicians, psychiatrists, psychologists, counselors, social workers, and other professionals may all care for the same client, but they may not share the same understanding of what collaboration should look like. They may have different schedules, different language, different documentation systems, and different expectations.
For private practice counselors, the barriers can be even greater.
They are often not part of a larger medical organization. They may have to initiate communication themselves. They may not know whether a physician will respond. They may not be compensated for the time spent coordinating care. They may have to navigate ethical boundaries, releases of information, scope of practice, and client consent carefully.
My study explored these lived experiences directly by interviewing ten private practice counselors who had collaborated with primary care physicians.
The goal was not to create a universal rule for every practice. The goal was to understand the meaning of the experience from the counselor’s perspective.
How the Study Was Conducted
This was a qualitative study using interpretive phenomenological analysis, also known as IPA.
IPA is a research approach that looks closely at lived experience. Rather than reducing the topic to numbers alone, it asks: What does this experience mean to the people living it?
For this study, I interviewed ten private practice counselors who had experience communicating with primary care physicians on behalf of their clients. The counselors were asked about their experience of collaboration, treatment planning, barriers, professional identity, client care, and the value they found in collaborative work.
Through the analysis, seven major themes emerged:
Communication difficulties hinder collaboration
Absence of monetary compensation
Positive interactions promote clinical growth
Differences in scope of practice provide value
The counselor as client advocate
Collaboration enhances holistic treatment
Initiating communication for medication management
Together, these themes tell a story that is both practical and deeply human.
Counselors want to collaborate. They see the value. They believe clients benefit. But the systems around them do not always make collaboration easy.
Theme 1: Communication Difficulties Hinder Collaboration
One of the clearest findings was that communication is both essential and difficult.
Eight of the ten participants described challenges communicating with primary care physicians. These challenges included phone tag, scheduling conflicts, difficulty reaching the physician, limited follow-up, or feeling dismissed during the interaction.
This is not surprising. Counselors and physicians often work under very different schedules. A physician may have short appointment windows, urgent calls, and a full patient load. A counselor may be in back-to-back therapy sessions and unable to answer the phone when a doctor calls back.
Even when both professionals want to communicate, timing can become a barrier.
Some counselors described initial contact as possible, but follow-up as much harder. This matters because collaboration is rarely a one-time event. Clients change. Medication changes. Symptoms change. Risk factors change. Family dynamics change. Treatment goals change.
A single conversation may help, but ongoing communication is often what makes collaboration truly effective.
When follow-up does not happen, care can become fragmented again.
Why Communication Matters in Mental Health Care
Communication between a counselor and a physician can help clarify concerns that may not be obvious in a standard appointment.
For example, a counselor may notice that a client’s anxiety increased after a medication change. A client may report side effects in therapy that they forgot to mention at a medical visit. A counselor may see patterns in mood, sleep, appetite, panic, trauma responses, or behavior that could be helpful for a physician to know.
Likewise, a physician may have information that helps the counselor better understand the client’s full picture. Bloodwork, medical history, medication plans, diagnoses, sleep concerns, hormonal changes, pain, or other health factors may all affect emotional well-being.
When communication works, the client is better supported.
When it does not, the client may be left trying to connect dots alone.
Theme 2: Absence of Monetary Compensation
All ten participants reported that they were not compensated for their time collaborating with primary care physicians.
This is one of the most important practical findings of the study.
Counselors may believe collaboration is beneficial. They may see it as ethical, clinically useful, and aligned with advocacy. But in private practice, time spent on collaboration is often unpaid.
A counselor may spend time obtaining a release, calling a physician, leaving messages, reviewing concerns, documenting the communication, and following up with the client. That time may not be reimbursed by insurance. It may not fit neatly into a billable session. It may become part of the invisible labor of good clinical care.
The participants did not describe collaboration as financially rewarding. They described it as meaningful because it helped the client.
That distinction matters.
The Invisible Work of Advocacy
Many people think of therapy as what happens during the session. But clinical care often includes work outside the session.
A counselor may coordinate with a school, physician, psychiatrist, dietitian, attorney, parent, partner, or other professional. They may write letters, prepare documentation, consult ethically, or help a client navigate systems that feel intimidating.
This work can be essential. But it is often unpaid.
The counselors in this study continued collaborating because they viewed it as part of client care. They saw it as advocacy. They saw it as a way to support better outcomes.
Still, the lack of compensation creates a barrier.
If integrated care is truly considered best practice, then the systems around it need to support the time it requires.
Theme 3: Positive Interactions Promote Clinical Growth
Despite the barriers, counselors also described meaningful and positive interactions with primary care physicians.
When collaboration went well, counselors felt respected. They felt heard. They felt that the physician valued their perspective. These positive interactions promoted clinical growth and strengthened the counselor’s professional identity.
This is an important finding because collaboration does not only benefit the client. It can also benefit the professionals involved.
When a counselor works with a physician who is open, respectful, and willing to share information, the counselor gains a broader understanding of the client’s care. They may feel more confident in their role. They may become more comfortable initiating future collaboration. They may also feel more grounded in the value they bring to the health care team.
Positive collaboration can help counselors feel that they have a seat at the table.
Collaboration Builds Confidence
Counselors are trained to understand emotional, behavioral, relational, developmental, and psychological patterns. They often spend more time with clients than many other health professionals do.
That time matters.
A counselor may hear the client’s fears, doubts, habits, avoidance patterns, family stressors, and internal conflicts. They may understand how the client thinks, what the client avoids, and what motivates the client to change.
When physicians respect that insight, collaboration becomes more than a referral. It becomes a shared effort.
That kind of professional respect can help counselors grow in confidence and clarity. It reinforces that mental health is not separate from health. It is part of health.
Theme 4: Differences in Scope of Practice Provide Value
Another major theme was the value of different professional roles.
Counselors and physicians do not do the same job, and that is the point.
A physician brings medical training, diagnostic knowledge, prescribing authority, and an understanding of the body from a medical perspective. A counselor brings training in mental health assessment, diagnosis, treatment planning, emotional processing, behavior change, trauma, relationships, coping skills, and client advocacy.
Different scopes of practice can create confusion when roles are unclear. But when each professional understands and respects the other’s role, those differences become valuable.
The goal is not for counselors to act like physicians or for physicians to act like counselors. The goal is for each professional to contribute from their own area of expertise.
Staying in Our Lanes Without Building Walls
The phrase “stay in your lane” can sometimes sound limiting. But in collaborative care, it can be helpful when understood correctly.
A counselor should not practice medicine. A physician should not be expected to provide long-term psychotherapy in a brief medical visit. Each provider has training, ethics, responsibilities, and limits.
But staying in one’s lane does not mean building walls.
It means understanding the lane clearly enough to communicate with the professionals in the lanes beside you.
For clients, this can be incredibly helpful. It allows care to become more complete without becoming blurred or unsafe.
Theme 5: The Counselor as Client Advocate
Every participant in the study identified advocacy as part of the counselor’s role.
This may be one of the most meaningful findings.
Counselors did not collaborate simply because it was efficient. They collaborated because they believed it helped the client feel seen, supported, and better understood.
Advocacy can take many forms. It may mean helping a client prepare questions for a doctor. It may mean encouraging a client to report medication side effects. It may mean supporting a referral to a specialist. It may mean contacting a physician with the client’s consent to share concerns. It may mean helping the client feel less alone in a complicated system.
For many clients, medical systems can feel overwhelming. They may worry they will not be believed. They may forget what they wanted to ask. They may feel rushed. They may not know which symptoms matter. They may not understand the connection between their physical and emotional health.
A counselor can help the client find language, confidence, and direction.
Advocacy Is Not Taking Over
Client advocacy does not mean speaking over the client or removing their autonomy.
In counseling, advocacy should empower the client. It should help the client better understand their needs, communicate more clearly, and participate more actively in their care.
The counselor’s role is not to control the medical conversation. It is to support the client in receiving more complete care.
That may include helping the client recognize patterns, name symptoms, ask for clarification, and follow through with next steps.
When done ethically and with consent, counselor advocacy can strengthen the client’s voice.
Theme 6: Collaboration Enhances Holistic Treatment
A central idea throughout the dissertation was the importance of holistic care.
Holistic treatment does not mean ignoring medicine. It does not mean replacing evidence-based care with vague wellness language. It means viewing the client as a whole person.
A whole person has a body, mind, history, nervous system, family system, culture, relationships, stressors, habits, beliefs, and environment.
Counseling is uniquely positioned to hold that complexity.
When counselors collaborate with physicians and other professionals, treatment can become more complete. A client’s depression may be understood alongside thyroid concerns, grief, sleep disruption, medication side effects, or chronic pain. A client’s anxiety may be understood alongside caffeine use, trauma triggers, cardiac symptoms, hormonal changes, or family stress. A client’s disordered eating may be understood alongside shame, control, nutrition, medical risk, and emotional regulation.
The more complete the picture, the better the care can become.
The Mind-Body Connection Is Not Optional
The mind-body connection is not a side topic in counseling. It is central to how people experience distress and healing.
Stress can become physical. Physical illness can become emotional. Trauma can affect the body. Chronic pain can affect mood. Depression can affect energy and movement. Anxiety can affect digestion, breathing, sleep, and concentration.
When care is siloed, these connections may be missed.
When care is collaborative, providers can better understand how symptoms interact.
This does not mean every client needs a large team of professionals. But it does mean counselors should remain aware of the physical dimensions of mental health and the mental health dimensions of physical illness.
Theme 7: Initiating Communication for Medication Management
Medication management emerged as another important theme.
Counselors do not prescribe medication, but they often hear about medication experiences in detail. Clients may talk about side effects, fears, confusion, missed doses, changes in mood, or concerns about whether medication is helping.
Because counselors often meet with clients regularly and for longer periods than many medical providers, they may notice changes over time.
This can make collaboration with prescribing providers very important.
A counselor may encourage a client to speak with their physician about side effects. With proper consent, the counselor may also communicate concerns directly. This can help the physician make more informed decisions and help the client feel supported.
The Counselor’s Role in Medication Conversations
The counselor’s role is not to tell a client what medication to take. It is not to adjust medication or give medical advice.
The counselor’s role is to help the client observe, reflect, communicate, and advocate.
For example, a counselor might help a client track mood changes after starting a medication. They might ask whether the client has told the prescribing provider about fatigue, appetite changes, irritability, panic symptoms, or sleep disruption. They might help the client prepare for a follow-up appointment.
This is especially important when clients feel intimidated or unsure.
Medication can be a valuable part of treatment, but it should not happen in a vacuum. Counseling can help clients understand their experience and communicate more effectively with their medical providers.
What Collaboration Means for Counselor Professional Identity
One of the central questions in my study was how collaboration shapes counselor professional identity.
Professional identity is not only about a title or license. It is about how counselors understand their role, value, responsibilities, and contribution to client care.
The counselors in this study did not describe collaboration as something that weakened their identity. Instead, many described it as something that strengthened their identity.
Collaboration helped them see their role more clearly. It reinforced their value as advocates. It helped them understand the importance of their clinical observations. It allowed them to participate in care beyond the therapy room while still respecting ethical and professional boundaries.
In other words, collaboration did not make counseling less distinct. It made the counselor’s distinct contribution more visible.
Why Private Practice Counselors Matter in Integrated Care
Private practice counselors are a major part of the mental health system.
Many clients receive therapy in private practice, not in hospitals or medical clinics. That means any serious conversation about integrated care must include private practice counselors.
It is not enough to build collaborative models only in large systems. We also need to understand how collaboration works in everyday private practice.
Private practice counselors may not have built-in access to physicians. They may not share electronic records. They may not have a care coordinator. They may not be paid for consultation. But they are still often the professional who hears the client’s full story week after week.
Their perspective matters.
If private practice counselors are left out of integrated care conversations, then many clients are left in a gap between medical and mental health systems.
Barriers That Still Need to Be Addressed
The study showed that counselors value collaboration, but it also revealed real barriers.
Time
Counselors and physicians both have demanding schedules. Finding time to connect can be difficult.
Access
Counselors may not know the best way to reach a physician. Calls may go through office staff, voicemail, or patient portals that are not designed for provider-to-provider communication.
Follow-Up
Even when initial contact happens, ongoing communication can be inconsistent.
Compensation
Counselors are often not paid for the time spent coordinating care, even when that coordination benefits the client.
Role Clarity
Professionals may not always understand one another’s scope of practice, training, or clinical value.
System Design
The health care system is not always structured to support collaboration between independent providers.
These barriers do not mean collaboration is impossible. They mean collaboration needs better systems, clearer expectations, and more support.
What Needs to Change
The findings point to several important areas for growth in the counseling profession and the broader health care system.
Counselor Education Should Include Collaboration
Counselors-in-training should learn how to collaborate with medical professionals ethically and effectively. This includes understanding releases of information, communication boundaries, scope of practice, documentation, and professional confidence.
Private Practice Needs Practical Models
Private practice counselors need realistic collaboration models that work outside hospitals and large health systems. These models should account for time, communication, consent, documentation, and payment.
Physicians and Counselors Need Shared Language
Collaboration improves when professionals understand one another. Cross-disciplinary education could help physicians understand the counselor’s role and help counselors communicate more effectively with medical providers.
Systems Should Support Care Coordination
If collaboration is considered part of best practice, then insurance systems, practice policies, and professional standards should better support the time required to do it well.
Clients Should Not Have to Coordinate Everything Alone
Clients should be empowered, but they should not be abandoned to manage complex systems without support. Collaboration can reduce that burden and improve continuity of care.
What This Means for Clients
For clients, collaborative care can feel like relief.
It can mean not having to explain everything alone. It can mean knowing that your counselor sees the bigger picture. It can mean feeling supported when talking to a physician about symptoms, medication, or concerns. It can mean your mental health is treated as part of your overall health, not as something separate or secondary.
At Wendie Lubinsky Counseling, this whole-person view matters.
Whether a client is seeking counseling in Holly Springs, Cary, or through another care setting, the goal is not only to reduce symptoms. The goal is to understand the full person. That includes emotional health, physical health, relationships, stress, family history, trauma, coping patterns, and the systems that shape daily life.
Good counseling does not happen in a vacuum.
The Future of Counseling Is Collaborative
The future of mental health care should not require clients to choose between medical care and emotional care. It should not require counselors and physicians to work in isolation when communication could support better outcomes.
My research showed that private practice counselors are willing to collaborate, even when the process is difficult and unpaid. They do it because they believe it helps the client. They do it because advocacy is central to counseling. They do it because holistic care reflects the reality of human experience.
People are not symptoms on a checklist.
They are whole human beings with interconnected needs.
If we want care to be truly effective, our systems must begin to reflect that truth.
Final Thoughts
Integrated collaborative care is not perfect. It is not always simple. It requires time, communication, ethical clarity, and mutual respect. It also requires professionals to recognize that no single provider can hold every piece of a client’s story.
But when collaboration works, it can strengthen care.
It can help counselors grow in professional identity. It can help physicians better understand the emotional and behavioral dimensions of health. Most importantly, it can help clients feel supported as whole people.
The counseling profession has an opportunity to lead in this space.
By advocating for collaboration, training future counselors in integrated care, and building stronger relationships with medical professionals, we can move toward a model of care that is more connected, more compassionate, and more reflective of how healing actually happens.
