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article of the month
We will feature a new article here each month written by one of our group members. These articles are offered free for your information and are not meant to provide individual advice or psychotherapy.

November 2007


by Malcolm Miller, Ph.D.


When you see a therapist, are you aware how many other professionals you are also seeing who are important to your treatment?

When I am seeing a married client, the spouse may also be seeing a therapist. There may also be a couple therapist. One or more of the children may be seeing a therapist. If the client has a addiction problem, (s)he may very well be in a 12 step program and have a sponsor (if not, I will recommend it). The client may be seeing a psychiatrist for medication to treat anxiety or depression. The client could also be seeing a physician for high blood pressure medication, migraines, or hormone treatment. You might not realize it, but the latter physician is also indirectly involved in one’s mental health treatment—medications can affect mental functioning. Also migraines and high blood pressure may respond to psychotherapy, in addition to or instead of medication. The client may be receiving medication to help with sleep difficulties from the physician, which the client sees as “medical” when it is actually “psychological.”

Have I exhausted everyone that might be involved? No. There also may be a pastor, priest or rabbi with whom one may discuss emotional concerns. There can also be a chiropractor and trainer. If one is contemplating a divorce, there may be attorneys. If the client is a child, there may be, in addition to all the others (since the parents may be in treatment), teachers, counselors, coaches and even probation officers.

You may be saying to yourself right now, “Gee I’m glad I’m not one of the people he is taking about!” I would suggest you stop, think, take out a pen and paper, and actually write down all the professionals who are involved directly or indirectly with your mental health. Be honest with yourself; they do not need to have a Ph.D., M.D., L.C.S.W., or M.F.T. at the end of their names to qualify. And I am not even including your spouse, boss, coworkers, or friends, who are beyond the scope of this article—but who definitely at times offer suggestions to improve your emotional life. Am I correct, the number is a lot larger than you originally thought?

How does one keep all of these professionals straight? It is hard enough when you are getting advice from one person, what do you do when you would need a conference hall to bring everyone together whom you are talking to?

Before I discuss how to keep all of these straight, it is important to understand why you need to keep them straight. All of these professionals may be quite good in their particular area of expertise, but in combination they may lead to confusion or incorrect advice. The reason is they are not looking at the whole picture or taking into account what you are taking or learning from others. I will give a few brief examples. Medications given independently by a general practitioner and a psychiatrist could weaken or dangerously increase the effects of the medications given by the other. An individual therapist’s recommendation could run completely counter to the goals of couple therapy and vice-versa. If the professionals were to speak to one another, a more consistent approach could be developed that would be more helpful. Often divorce attorneys’ focus is to obtain the best financial settlement (most money) for their client, regardless of the impact on the relationship. If there are children involved, this could lead to winning the battle but losing the war. How can these parents, possibly hating each other as a result of both the marital difficulties and the divorce settlement, work together to make the best decisions for their children over the years? The reality of this has led to a new approach by some divorce attorneys, called “the amicable divorce.”

The how is to make certain these professionals talk to each other every few months, share information and work out opposing perspectives. Obviously, there are times when one does not want the professionals talking to each other. People seeing only individual therapists may correctly wish to keep what they discuss confidential from the therapists seeing other members of the family. Except for this situation, it is often best if one professional is designated the role of coordinator; that person contacts the others on a regular basis and makes certain the others are communicating. Leaving it more loosely structured usually results in everyone getting caught up in their regular work schedule and not contacting each other. If someone is not willing to talk regularly to the other professionals involved, even though it would be in the best interests of the client, this person might not be the best choice in this case. One caveat is, if the consulting time is extensive, some of the professionals may request additional payments. This is reasonable and well worth the added expense.

As an important aside, you need not be concerned that an ethical therapist will speak to other professionals behind your back. A specific signed release of information is required to disclose confidential material about you (even that the therapist has you as a client), and you can ask the therapist and the other professionals to explain to you what will be discussed and to learn the results of this discussion.

I hope this article clarifies for you the amount of input you receive from others that impacts your emotional well being. I hope it also explains the need for there to be intercommunication among the range of professionals involved and how this may be accomplished to assist you in the present and in your future growth.

Please refer to Psych Bytes for additional examples of useful coordination.


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