Preferred Name
Tiffany Snow
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
ORCID
https://orcid.org/0009-0003-4232-3553
Date of Graduation
5-14-2026
Semester of Graduation
Spring
Degree Name
Doctor of Philosophy (PhD)
Department
Department of Graduate Psychology
First Advisor
Stephanie Crockett
Second Advisor
Robin Anderson
Third Advisor
Viki Kelchner
Abstract
Abstract
The counseling profession has historically differentiated its identity by emphasizing a wellness-oriented approach. However, this has often led to the exclusion of counselors from integrated behavioral healthcare (IBH). With the 2024 enactment of the Mental Health Access Improvement Act, counselors now have unprecedented opportunities to serve as behavioral health providers in federal medical settings. This three-manuscript dissertation explores the intersection of counselor professional identity, social determinants of health (SDoH) competency, and interprofessional collaboration within IBH.
Manuscript 1 presents a conceptual framework for reconciling traditional counselor identity with the "medical model" of Primary Care Behavioral Health (PCBH), arguing that this model is a natural extension of counseling’s social justice values. Manuscript 2 utilizes Interpretative Phenomenological Analysis (IPA) to explore the lived experiences of five licensed professional counselors in IBH. Four themes emerged: (a) integration as a mechanism for access and coordination; (b) whole-person, brief-medical-paced counseling; (c) professional growth in role and identity; and (d) navigating complex healthcare systems. Manuscript 3 reports on a quantitative study (N = 175) examining characteristics of counselors in IBH. Results indicated that while professional identity, SDoH competency, and collaboration skills are positively correlated, SDoH competency is the strongest predictor for working in IBH, whereas a traditional differentiated identity served as a negative predictor.
Collectively, these findings suggest an "identity tension" rooted in traditional training and professional identity. This dissertation concludes with a call for counselor education to embrace IBH as a social justice mandate, ensuring the profession is poised to lead in the evolution of equitable healthcare.
Keywords: counselor professional identity, integrated behavioral health, social determinants of health, social justice advocacy
Included in
Counselor Education Commons, Other Mental and Social Health Commons, Social Justice Commons
