Date of Award


Degree Name

Doctor of Philosophy


Counselor Education and Counseling Psychology

First Advisor

Dr. Suzanne M. Hedstrom


Over the past several years there has been a paradigm shift within the primary care delivery system from a traditional medical approach of providing behavioral health services to an integrated primary behavioral health model. This shift in patient care presents new opportunities for professional counselors to assume a role working in the health care arena. Currently there is a lack of research exploring the experiences of counselors working in this model. In addition, there is a deficit in the existing counseling literature specifically examining how working in this setting may potentially influence counselor identity. In an effort to inform counselors as well as contribute to the literature in the field of counseling this study examined the experiences of six counselors working in integrated primary behavioral health settings and explored how their experiences influenced their identities as counselors.

Participants identified rewards of working in an integrated primary behavioral setting such as collaborating with medical providers, learning from each other and satisfaction in working with patients in this model. The challenges described by participants included working within the culture of the medical model and the difference in approaches to patient care between medical providers and counselors. When describing the impact on counseling skills of working in an integrated setting, participants shared the changes they made in their counseling skills as well as in their treatment approach in working with patients. Finally, counselors shared their unique experiences of how they perceived working in an integrated setting has influenced their professional identity by the way they conceptualized their role working with patients in this model as well as how they have changed how they identified their role, and experienced a sense of purpose in their role. Influences from the environment and interactions with others emerged as the two universal themes from participants' descriptions of their work experiences.

Implications are provided for counselors working in this setting as well as for counselor educators, supervisors, counselors in training, and for health care organizations considering implementation of such a model of patient care. Limitations of the study are described, and recommendations for further research are discussed.

Access Setting

Dissertation-Open Access