GOOD OR BAD – MORE THAN ONE FAMILY MEMBER SEEING THE SAME THERAPIST?
With all the concerns about the COVID 19 virus, more individuals, couples and families will perhaps be entering therapy. The reality of these fears and the changes in lifestyle due to home sheltering, job losses, and economic impact may bring more longstanding issues to the surface. The question of the same or separate therapists will likely arise. Below are some points to ponder.
First, let me be clear that I am not referring to family members involved in couple, parent-child, or family therapy sessions. In those situations, of course, the therapist sees members of the same family, usually at the same time.
This discussion centers on whether different forms of therapy should occur with the same therapist with members of the same family. For example, should a therapist be seeing one partner in individual therapy and also be treating both partners in couples therapy? Should the same therapist be seeing a h the parent and child in their own individual therapies? You and the other family members, in consultation with the therapist, need to examine your own thoughts and feelings about yourself, the needs of other members of your family, and the capabilities of the particular therapist for multiple therapies.
Points in Favor
- Less repetition and confusion.
Having the same therapist means that history, current circumstances and various information do not need to be fully repeated. This saves on time and energy repeating information, and reduces the number of sessions. Savings result in the cost of therapy. Also, if there are inconsistencies among family members, these will be more quickly and clearly noted when the therapist is the same person.
- There is greater congruity.
Therapists have different theoretical orientations, styles, and personalities. Although these differences can be valuable, in combination they may lead to contradictions. The family members, incorporating what they have learned, may be coming from very different perspectives, and therefore, be confused and unsure of how best to apply what they learn from therapy.
An example would be one therapist recommending exploring the individual’s or family’s historical pattern of dealing with stress, while the other therapist is recommending a problem-solving effort. If there are family sessions and individual sessions discussing parent/child issues, one therapist could come from a more firm perspective and the other from a more “give and take” perspective, also resulting in confusion and frustration. Seeing only one therapist prevents these situations from occurring.
Furthermore, although the therapist is committed to the needs of whomever he is meeting with at the time, the overall treatment can fit more like a mosaic, with the same therapist, rather than a combination of separate pieces , as can occur with multiple therapists. For example, there have been times when I have seen a husband and wife individually to focus on their individual issues in addition to couple sessions. Each felt that, although I was focused on their individual needs, I was attuned to their desire that solutions ultimately needed to be congruent and in the interest of both.
- There can be greater trust.
If the first client in treatment trusts the capability of the therapist, he will be more trusting of the competency of the therapist meeting later with another family member. Similarly if a member of the family has liked the work the therapist did with another member of the family, he may feel less uneasy going to the same therapist.
A specific example involved my seeing a husband who was having difficulties with career issues. The wife felt positive about the assistance I had provided him, and she wanted me to help with issues she had with her mother and felt confident in my abilities. Later they both returned to me for assistance with their relationship.
Although it would be simpler if we left it here, there are some very serious cautions that need to be evaluated. A critical factor that enabled the above therapies to be successful was the fact that the clients and I thoroughly explored the following points against.
Points Against
- Trust–questioning whether the therapist has the client’s interests in the forefront.
In successful therapy clients need to feel assured that the therapist has their needs as primary. Clients have different levels of trust and security. Some clients are quite apprehensive that, if the therapist is meeting with another member of the family, the therapist will be incorrectly influenced in favor of the other family member. In this situation, the client’s significant trust concerns will likely lead to a recommendation for separate therapists.
- Confidentiality concerns–worry that private information will be revealed, even by honest mistake, with another member of the family.
For example, a client may discuss a trauma he experienced as a child. The client is not yet ready to discuss this with their partner and may be afraid the therapist might inadvertently share this information in a couples session. If this is a significant concern, it must be honored and different therapists are best.
- Differences in personalities and style.
A therapist who is very successful with one member of a family may not be with another. Also some therapists are better with one mode of therapy, such as individual, and another therapist may have more skills working with families, etc.
- Problems in therapeutic neutrality.
This is a very critical and tricky issue that can potentially compromise the therapy. A couple of examples will clarify this point. If the therapist is seeing both the couple and one or more members of that couple individually, the therapist needs to be able to express or interpret what is best for the client. In couple therapy, the client is the couple; in individual therapy, the client is that particular individual. Sometimes what is best for the individual may not be in the best interest of the continuing couple relationship and vice-versa. For example, let us say the shared goal of couple therapy is to work out differences and continue the relationship. In the individual therapy, it becomes clear to the therapist that this relationship may be harmful to the client, repeating issues from the past that are destructive to the individual. The therapist needs to feel he can explore this issue in the individual therapy to best meet the needs of his client–in this instance the individual. This may very well be in conflict with the goals of the couple therapy, and the therapist needs to be honest in both therapies. If the therapist is seeing both the individual and the couple, he may end up doing an artificial juggling act. It is best if this possibility can be avoided at the beginning of treatment. I therefore recommend to new couple clients that we have dual goals of assessing whether the issues can indeed be worked out to meet both of these needs, and, if they can, to work on ways to achieve this. A few preliminary sessions might be needed to develop a plan to go forward.
- The therapist keeping secrets.
Although this issue relates to the last point on therapist neutrality, it deserves its own section. This concerns the therapist being placed, or placing himself, in the position of keeping a critical relationship issue a secret from the other member of the family in treatment. An example of this would be a client revealing the plan to end the relationship at some point in individual therapy and not wanting it raised in couple therapy. If the therapist were to agree to this, it would clearly compromise the therapist’s neutrality in couple therapy, since he is colluding in keeping a secret from the partner.
Responsible therapists try their best to avoid this from the beginning by discussing in depth with clients the harm of relational secrets to the couple therapy and the critical importance of the therapist being able to maintain neutrality to best help them.
Final Thoughts
I hope that this article has raised your awareness and understanding of this issue. I encourage you to discuss your questions, should they arise, in therapy to help avoid the potential pitfalls.
I began writing this article planning on taking a neutral perspective. As I continued writing the “Points in Favor” and the “Points Against”, I felt the points against were actually much stronger. You and other family members can sign releases for the therapists to consult. This can reduce the conflicts of having more than one therapist working with different family members.
Dr. Malcolm Miller is a Clinical Psychologist practicing in West Los Angeles and Torrance, and he is a member of the Independent Psychotherapy Network. He may be contacted at (310) 822-8898 or mmillerphd@aol.com.
Copyright 2020 by Malcolm Miller, Ph.D.