Professional relations in multidisciplinary healthcare : a counselling psychology perspective
Primary care professionals work in settings which have traditionally been very hierarchical, and medical practitioners have occupied the dominant places in that hierarchy, possessing structural power through their affiliation with the social institution of medicine, and their control of funding. Counselling in primary care has been described as a fast evolving profession and Counselling Psychologists are filling many of these newly created posts, cautionary notes concerning the impact of the NHS reforms of recent years on the discipline have been raised. This study was designed to raise awareness of some key factors impacting on the process of communication in multidisciplinary working in primary care relevant to counselling psychologists, and to explore multidisciplinary working in health care from a psychological discourse analysis perspective. Three different workshops were run comprised of multidisciplinary groups brought together for the purpose of the study. Each team were trained in the Community Oriented Primary Care (COP) model and then audio- and videotaped constructing a COPC programme to address depression in older people. Analysis of the group transcripts was carried out exploring power relations, competing agendas and ideological patterns. Conclusions are that 1. COPC may have had limited application due to difficulties implementing the nonhierarchical multidisciplinary working aspect of the model. 2. Counselling Psychology has much to contribute to multidisciplinary working and could foster true innovation in primary care through broadening the clinical perspective. 3. Counselling Psychologists need to be aware of the power of medical discourse in the environments in which they work, and the resistance of primary care to change which can emerge through the promotion of the medical agenda and the language used in multidisciplinaryworking in medical settings.