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THE BENEFITS OF HAVING THE PROFESSIONALS YOU SEE TALK WITH EACH
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
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
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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