The Atlantic

Therapy for Everybody

In Appalachia, a primary-care clinic offers quick bursts of psychotherapy on the spot.
Source: Elaina Natario / Katie Martin / The Atlantic

JOHNSON CITY, Tennessee—The first patient of the morning had been working 119 hours a week. Greta (not her real name) had been coming home late at night, skipping dinner, and crashing into bed. One recent night, her college-aged daughter melted down, telling an exhausted Greta that her parents’ marital tensions were putting a strain on her.

“She’s like, ‘Why don’t you just divorce him?’” Greta recounted to her psychotherapist, Thomas Bishop, who was perched on a rolling stool in the bright examination room. “‘Why don’t you just do it and get it over with?’” Greta planned to stay with her husband, but her daughter’s outburst worried her. “Is this going to affect the way she feels about relationships?” she asked Bishop.

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

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