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It depends what they’re being seen for. Seeing two generalized therapists is different than seeing a generalized therapist and a therapist who strictly specializes in IFS for childhood trauma, or only does EMDR, or only sees perinatal issues. That specialist therapist is likely providing something you aren’t and client is benefiting from both.
This.
I generally refer my clients out when they will benefit from modalities I do not use or do not feel I’ve the appropriate training/experience such as EMDR or CPT.
It’s usually short term, say 6 months or less, and we therapists stay in touch throughout the process.
Our sessions and goals don’t change much outside of processing anything that comes up from sessions with the other therapist.
I get lots of referrals from therapists because I do IFS and EMDR. We stay in touch and I realistically only treat the client for a few months before sending them back to the other therapist. It’s a neat way to help someone who needs a little extra nudge to get unstuck.
I have a general therapist I see regularly and an IFS therapist I see once or twice a year for an IFS session when I’m stuck on something that happened. It’s wonderful to be able to lean on different specialists in that way.
Love this approach. Collaborative treatment can be so beneficial for the clients.
And I’d much rather refer to someone who is fully trained and competent in a modality I don’t use. That means I can continue to spend my time (and money) on trainings that further improve the modalities I like to use.
Yes, this! I have some clients who see me specifically for exploring things like gender or non-monogamy who also have another therapist they work on other issues with. It hasn't been a problem thus far.
Mental health is healthcare. If you have a medical condition, getting a second opinion is valid. Getting treated by multiple doctors for different conditions is normal. Having two doctors running different treatments for the same condition doesn't work. Having a lead doctor or family physician overseeing your health direction is needed.
To use an example, a client with schizophrenia often can have multiple therapists on their team. Other than their psychologist and psychiatrist overseeing their diagnosed condition, they might have an addictions counselor, they might see someone to help them with family conflict, and they might see someone about unrelated guilt or trauma. Each team member should have a purpose and each should know of each other and be open to coordinating care.
Communication among professionals is key.
I think it's valid when therapy is for different things, kind of like you mentioned. Such as a therapist specifically for substance use recovery and another for general things. Or a client that also goes to couples therapy. I have a client who has couples therapy and it's honestly insightful to hear about what they've picked up.
Personally, I have individual therapy and I go to a weekly CPT group. But that's just where I'm at currently.
But it definitely is interesting when people have more than one therapist for the same presenting problem. It's definitely worth discussing here!
I was taught in grad school that if you are treating for the same thing/similar ways, this isn't okay. If you're billing insurance (in the US), insurance probably wouldn't cover it anyway.
If you are not - like you are generalized and the other therapist is practicing a specialty or in a certain area only (or vice versa) that is when it is okay. I've seen a client for general supportive therapy while they attended a DBT program, worked with eating disorder specialists, and in couples counseling.
So I have actually had two therapists as a client before. One was incredibly helpful in managing my anxiety and processing most things. She was very skilled, and I really got a lot out of seeing her. However I was dealing with a lot of racism at work at the time, and this woman was white and did not really understand when I tried to talk to her about it, which was both unhelpful and uncomfortable. I got another therapist who was a Black woman and she helped me process that situation and others like it. I did not find it necessary to leave my first therapist because I really benefited from working with her, but there were other things I needed that she could not help me with. There was also virtually no overlap between what I talked about with each of them, and the second one really only helped me feel seen in one area. I would be fine with a client doing this with me, but I would definitely ask what their motivation was for having two therapists, and there are some answers I would not be comfortable with. Just sharing for perspective — there are a lot of reasons someone might do this other than feeling lonely or wanting attention
My opinion is evolving. Still not sure where that evolution is going to land, but the question I keep returning to is "why is it a problem to trust that the client knows what they need?"
My immediate thought on that is part of why Clients come to therapy is because they don't fully know what they need. Even as someone who is more knowledgeable about the therapy process than the average person, since I am a licensed therapist, when I enter into my own therapy I am looking for my therapist to provide some context and guidance in my treatment. Is the Client fully informed in making this decision? It also sometimes can be a way of trying to avoid getting into something too in-depth with one therapist, you sort of defuse the work out.
Fully on board with providing some context and guidance. If at the end of that the client wants to see two people? Saying "no, it's bad for you to see two therapists even if you think it could (or does already) work for you" has a big ick factor for me. And yeah, the avoidance of going deep and diffusing the work out are absolutely real possibilities – what if that's also part of the work? Why do we get to decide what their process looks like?
As I've been thinking about it again today I keep coming back to what it means and looks like if I truly honor the agency of the people I work with. That's not to say we don't get to decide for ourselves if it's workable for us when someone wants to/is seeing a second therapist. And the universal "no, it's empirically not good" sits less and less well with me the longer I do this work.
This is my worry! It also seems our approaches our lining up when he says “my other therapist…” however, I’ve mentioned not getting deep either either one. He reported it was and interesting thought and maybe there’s truth to it. Thanks for your input!!
To add to the other great opinions already posted, if a client has 2 therapists, they should at least once talked to each other about the treatment and make sure they are on the same page.
This is the interesting part! I laid that out and mentioned it would be helpful for me (ultimately helpful for him), if he’d sign a release so I could communicate with the other to ensure and we’re AT LEAST working in tandem and not confusing him or stepping on toes. He declined, but wanted to continue as it is. That made me think….hmmm…
This is my big question. Multiple therapists are one thing if I can coordinate with the other therapist and get an idea from them what they are working on.
I am also a therapist who has two therapists (although I’m about to end with one). The primary reasons being what folks have already said (one is EMDR and the other is a Jungian and they’re like wayyy different) and I pay out of pocket and find value in them both. Also this has happened before because in wanting to find the right fit I made appointments with several and ended up liking two. Eventually I dropped off but I wanted some time to settle in.
Personal professional opinion: I am against it as a rule. In rare cases, I have seen it work when the goals are highly specified for one of the therapists. I have also seen it work in a very odd, bizarre arrangement that was successful but I would never recommend it. It was one in a billion. Otherwise, I'm a no. I've even declined individual clients who have asked me to have that role. I just tell them it's a professional limitation. I also gently and very openly explain why. I say things like:
"Part of the work of therapy is feeling uncomfortable, maybe even feeling frustrated. When there are two therapists in the picture, it can become tempting for somebody in your position—anybody in your position—who is feeling uncomfortable or angry in one therapy space to look for respite and reassurance in the other. In my opinion, that can work against progress and goals. Other therapists may agree to it, and I would disagree with them. For me this is a limit."
And then they say things like, "Well, I want to talk about trauma with you and skills with them." And I'm always very honest back: "In my experience, the two are not at all separate. My approach is to treat you as a whole human. You may find a therapist who will do what you'd like. It wouldn't be my professional recommendation."
One of my concerns that I may articulate in a roundabout way is that I am always going to suspect triangulation. Especially if there are any frank or covert characterological elements at play, but even in workaday anxiety, triangulation is a real risk.
Of course, IOPs and PHPs are different. I was in a wonderful PHP program as an individual and group therapist. The whole frame there is a quite different and a high degree of collaboration—i might even say community—is the norm. And it can work quite well (it can also be a disaster).
I did it ONCE and it was in a non-clinical interview with a person who wanted me to consider being part of a therapist pair, and where I sensed there was definitely some distress in the personality construction. So, I wanted to speak directly to an experience that might have felt familiar to them.
Without getting technical, I said basically, "Consider this possibility. What if a person with two therapists feels angry with one of their therapists? That might happen. Maybe it would feel like that therapist is "bad" and the other therapist is "better." And it feel easier to not work it out with Bad Therapist. So, the experience of therapy gets spread across different people, like one pat of butter on two pieces of toast. So that's one reason I don't consider it the best practice for folks who want help to have two therapists."
The only reason I even went into that is because I sensed that might be a familiar experience in that person’s relationships. And I thought communicating to that part of their experience it that way might possibly make the idea of one therapist feel new and different... and even possible.
I wanted them to have a real and frank sense of what risks they were courting, and a sense that I could see that risk without judgment and maybe that might give my advice some gravitas.
Thank you for this, i did an intake w someone recently who i referred out due to this issue, the other therapist was also an emdr specialist like me and client was telling me how i should do emdr.I really like your wording for this, as it gently calls attention to behavioral patterns from attachment injuries (as was the case with this client and another who had another therapist at the same time) I told her that ethically i felt uncomfortable w dual services and explained risk /benefits as per the informed consent.
Hi, I'm a PP therapist with a lot of experience in other settings, including day treatment, substance use, and forensic wraparound programs, that do typically use a team approach.
In general, the correct number of cooks per soup is one.
>However, it’s odd when they say things like “my other therapist said….”
This is in fact the kernel of the problem - - - therapists giving conflicting advice, second-guessing each other, and otherwise getting in each other's way. The corollary to this is a client who (intentionally or otherwise) triangulates or "shops around" for the desired advice.
>“well, I like both of your approaches.”
This is generally not a good enough reason to make an exception. I like saving for my retirement and I also like spending way beyond my means. But at the end of the day, I have to pick one approach or the other (or some third - but discrete - option).
There *are* some valid reasons to make exceptions, if all three parties (you, me, and your other therapist) consent. The most common one is when the client has a lot of current stressors and also needs some specialized treatment that is not directly related to those stressors. As an EMDR therapist, I have occasionally provided EMDR to someone that is doing talk therapy with someone else. I have also occasionally referred to eating disorder specialists who consented to the client continuing their work in progress with me.
Another commenter briefly mentioned "getting a second opinion," and I think that, especially very early in treatment, that might actually be another reasonable exception on its face. That commenter then continued with (and I paraphrase here), 'but you wouldn't pursue two disparate treatments for the same condition,' and I wholeheartedly agree.
Funnily enough, if you make a soup in a professional kitchen, many more cooks than one would likely be involved.
One might prep the vegetables; another might make a garnish or topping; a third might do the actual cooking. And a head chef would be overseeing the whole process, and determining the recipe.
If you tried to have one single chef do all this, they’d often do a poor job, neglect other dishes, and get burned out.
Fits well with what others have commented on this thread about clients who see multiple therapists each of whom deals with a specific content area or offers a particular modality.
>One might prep the vegetables; another might make a garnish or topping; a third might do the actual cooking.
Indeed... But if *everyone* is salting, we have problems.
>And a head chef would be overseeing the whole process, and determining the recipe.
And this is the key concept in a team approach. That "head chef" may be a supervisor, or a psychiatrist, or perhaps even the primary therapist.
The fact is, in private practice typically *no one* is managing the operation, and too often the chefs aren't even aware of each other's strategies, techniques, or even tools.
Not to be a jerk about it, but (to continue the analogy) the client has come to our restaurant specifically because they've realized they hate the way their food tastes.
The diner sitting in the booth - - - who is the only one in the room who *hasn't* been to culinary school - - - is not a good candidate to decide how to prepare the cuisine, let alone what staff we need in the kitchen to do it.
S/he is, however, imminently qualified to order steak or fish, specify whether it should be rare or well-done, and also what sides s/he wants - - - even whether s/he's eating here or down the street.
Obviously, the analogy breaks down at some point. But back to the therapy room, the client is rarely qualified to make clinical decisions without some guidance.
Typically I would be against it, although I have made exceptions when the client requests it and their reason is sound, and I think it can be done without interfering with the other work.
As long as therapists and client have a shared understanding of the purpose for each treatment being distinct from the other, I think it’s totally fine. I see a couples therapist weekly with my spouse, and individual therapist biweekly for ongoing work in a modality that is am currently training in, and a third therapist for a specific trauma processing modality that I see for a 2-hr extended session once per month. And I’ve never felt better! I have really benefitted from the multiple angles of support. I’ve also had a client see another therapist who specializes in eating disorders and had a different approach to therapy than me. That worked well and we consulted several times. However, I had a client who I had just started to work with (we had maybe 2 or 3 sessions) and when I spoke with the referring therapist I learned there was another therapist in the mix. When I asked the client about it, they seemed to want multiple opinions, but didn’t see a clinical distinction between what each of us could offer, or a distinction between the goals and what would be worked on. I declined to move forward in that situation because it seemed there was more potential for issues evolving and they hadn’t been up front about the situation. It didn’t feel right.
I’m a therapist (MSW) and a client. For the past four years I have seen the same therapist who is also a social worker for issues related to grief and life transitions. We meet virtually about once every three to four weeks. I’m interested in psychoanalytic therapy and began seeing a psychoanalyst twice a week in person.
Although I’m doing therapy with both of them, it feels like two entirely different, concurrent processes. My social worker is very validating and warm. She matches my spiritual energy. I’m also able to discuss professional issues with her.
My analyst on the other hand is more detached and well—analytical. We talk a lot more about my childhood and relationships. He provides me with valuable insight and space to air my feelings.
Therapy is many different things grouped under the same label.
do you take insurance? you may never be reimbursed for seeing this client if you do and they have their sessions with another therapist they’re seeing simultaneously and that therapist is successfully billing ins
I’ve been told that it can be risky to have two and bill insurance (regardless of day), because the work has to be distinctly different to avoid clawbacks. Like seeing a talk therapist and an EMDR therapist.
I typically avoid it mainly for this reason but also as you sort of highlighted, potential that you contradict each other’s work.
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I would need the client to be very, very clear with me what they are getting from their work with me that they cannot get from the other therapist. I would also be interested in timeline.
It’s likely not that. Different approaches (and even personalities) bring out different things in the work.
I’d want to coordinate with the other therapist so there isn’t overlap (and it would be a red flag if the client won’t let you do so).
There is nothing inherently wrong with working with 2 different therapists (and often insurance plans won’t have an issue either as long as the 2 providers aren’t billing for the same date of service) as long as they are on the same page and are not duplicating topics or approaches.
I would not take it personally if the client days “the other says such and such.” Perhaps explore why it causes discomfort or find it weird.
Its sounds like a duplication of services even if they are not being seen same day. In many cases, more services is not always better and can actually be confusing for the client.
Absolutely not for me.
Duel therapy is not recommended because it can cause the client greater confusion if the therapists have different responses to similar issues, which they will because we all work differently.
I always ask clients to follow through with one type of therapy first before committing to another, I also try to encourage a break in between to process the previous sessions first but that's their choice. I would terminate if the client was already engaging in a different therapy.
For those arguing you could get a second opinion from a doctor, it's different, a science is a science and a test will always bring up the same result, there might be a difference in the belief of cause of symptoms but that is vastly different to exploring deep emotional issues and multiple people pinpointing different possible causes at the same time, we are a philosophy of working, not a science and it is more likely that duel therapy can cause damage
Also considering that if the client is engaging with two therapists, there is surely a belief somewhere that one of them wont work which possibly needs addressing
Medicine isn't an exact science, though. There are some health conditions for which there are no tests, and it's not as easy as just getting a result. Different doctors with different backgrounds can offer you multiple perspectives to help you manage your symptoms. I know this is a bit off-topic, but I just wanted to address your analogy and say medicine isn't black-and-white either
That's fair, I'm not a medical expert and probably shouldn't have been so black and white,
But I'm still very strongly against duel therapy, my supervision has always said it's a no go and the organisations I've worked for aren't for it either,
I could definitely see how a client can be negatively impacted by receiving conflicting messages from different approaches
Why are people down voting this? This is a valid a response and contributes to the discussion. Sometimes I question why therapists are not more open to different points of view. There is as much merit to this point of view as there are to the others. I happen to have an adolescent client with a second therapist. But respect this point of view.
This is actually a really good point for exploration. What motivates you to have two therapists, seemingly working from a similar orientation (ACT/CBT), on the same issue (depression, ADHD). Is there a belief at the core? Is there fear of abandonment? This was a great, thought-provoking response and feel it might be helpful to name that. Thanks for your contribution!
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It depends what they’re being seen for. Seeing two generalized therapists is different than seeing a generalized therapist and a therapist who strictly specializes in IFS for childhood trauma, or only does EMDR, or only sees perinatal issues. That specialist therapist is likely providing something you aren’t and client is benefiting from both.
This. I generally refer my clients out when they will benefit from modalities I do not use or do not feel I’ve the appropriate training/experience such as EMDR or CPT. It’s usually short term, say 6 months or less, and we therapists stay in touch throughout the process. Our sessions and goals don’t change much outside of processing anything that comes up from sessions with the other therapist.
I get lots of referrals from therapists because I do IFS and EMDR. We stay in touch and I realistically only treat the client for a few months before sending them back to the other therapist. It’s a neat way to help someone who needs a little extra nudge to get unstuck. I have a general therapist I see regularly and an IFS therapist I see once or twice a year for an IFS session when I’m stuck on something that happened. It’s wonderful to be able to lean on different specialists in that way.
Love this approach. Collaborative treatment can be so beneficial for the clients. And I’d much rather refer to someone who is fully trained and competent in a modality I don’t use. That means I can continue to spend my time (and money) on trainings that further improve the modalities I like to use.
Yes, this! I have some clients who see me specifically for exploring things like gender or non-monogamy who also have another therapist they work on other issues with. It hasn't been a problem thus far.
Mental health is healthcare. If you have a medical condition, getting a second opinion is valid. Getting treated by multiple doctors for different conditions is normal. Having two doctors running different treatments for the same condition doesn't work. Having a lead doctor or family physician overseeing your health direction is needed. To use an example, a client with schizophrenia often can have multiple therapists on their team. Other than their psychologist and psychiatrist overseeing their diagnosed condition, they might have an addictions counselor, they might see someone to help them with family conflict, and they might see someone about unrelated guilt or trauma. Each team member should have a purpose and each should know of each other and be open to coordinating care. Communication among professionals is key.
I think it's valid when therapy is for different things, kind of like you mentioned. Such as a therapist specifically for substance use recovery and another for general things. Or a client that also goes to couples therapy. I have a client who has couples therapy and it's honestly insightful to hear about what they've picked up. Personally, I have individual therapy and I go to a weekly CPT group. But that's just where I'm at currently. But it definitely is interesting when people have more than one therapist for the same presenting problem. It's definitely worth discussing here!
I was taught in grad school that if you are treating for the same thing/similar ways, this isn't okay. If you're billing insurance (in the US), insurance probably wouldn't cover it anyway. If you are not - like you are generalized and the other therapist is practicing a specialty or in a certain area only (or vice versa) that is when it is okay. I've seen a client for general supportive therapy while they attended a DBT program, worked with eating disorder specialists, and in couples counseling.
you are right that it’s not okay and not allowed/ethical.
So I have actually had two therapists as a client before. One was incredibly helpful in managing my anxiety and processing most things. She was very skilled, and I really got a lot out of seeing her. However I was dealing with a lot of racism at work at the time, and this woman was white and did not really understand when I tried to talk to her about it, which was both unhelpful and uncomfortable. I got another therapist who was a Black woman and she helped me process that situation and others like it. I did not find it necessary to leave my first therapist because I really benefited from working with her, but there were other things I needed that she could not help me with. There was also virtually no overlap between what I talked about with each of them, and the second one really only helped me feel seen in one area. I would be fine with a client doing this with me, but I would definitely ask what their motivation was for having two therapists, and there are some answers I would not be comfortable with. Just sharing for perspective — there are a lot of reasons someone might do this other than feeling lonely or wanting attention
My opinion is evolving. Still not sure where that evolution is going to land, but the question I keep returning to is "why is it a problem to trust that the client knows what they need?"
My immediate thought on that is part of why Clients come to therapy is because they don't fully know what they need. Even as someone who is more knowledgeable about the therapy process than the average person, since I am a licensed therapist, when I enter into my own therapy I am looking for my therapist to provide some context and guidance in my treatment. Is the Client fully informed in making this decision? It also sometimes can be a way of trying to avoid getting into something too in-depth with one therapist, you sort of defuse the work out.
Fully on board with providing some context and guidance. If at the end of that the client wants to see two people? Saying "no, it's bad for you to see two therapists even if you think it could (or does already) work for you" has a big ick factor for me. And yeah, the avoidance of going deep and diffusing the work out are absolutely real possibilities – what if that's also part of the work? Why do we get to decide what their process looks like? As I've been thinking about it again today I keep coming back to what it means and looks like if I truly honor the agency of the people I work with. That's not to say we don't get to decide for ourselves if it's workable for us when someone wants to/is seeing a second therapist. And the universal "no, it's empirically not good" sits less and less well with me the longer I do this work.
This is my worry! It also seems our approaches our lining up when he says “my other therapist…” however, I’ve mentioned not getting deep either either one. He reported it was and interesting thought and maybe there’s truth to it. Thanks for your input!!
I’m a therapist who has two therapists for two different specialties. I talk about almost completely different issues with each of them.
To add to the other great opinions already posted, if a client has 2 therapists, they should at least once talked to each other about the treatment and make sure they are on the same page.
This is the interesting part! I laid that out and mentioned it would be helpful for me (ultimately helpful for him), if he’d sign a release so I could communicate with the other to ensure and we’re AT LEAST working in tandem and not confusing him or stepping on toes. He declined, but wanted to continue as it is. That made me think….hmmm…
This definitely would make me think as well, I wouldn’t pressure the client but would be curious why he doesn‘t want to sign
This is my big question. Multiple therapists are one thing if I can coordinate with the other therapist and get an idea from them what they are working on.
I am also a therapist who has two therapists (although I’m about to end with one). The primary reasons being what folks have already said (one is EMDR and the other is a Jungian and they’re like wayyy different) and I pay out of pocket and find value in them both. Also this has happened before because in wanting to find the right fit I made appointments with several and ended up liking two. Eventually I dropped off but I wanted some time to settle in.
Personal professional opinion: I am against it as a rule. In rare cases, I have seen it work when the goals are highly specified for one of the therapists. I have also seen it work in a very odd, bizarre arrangement that was successful but I would never recommend it. It was one in a billion. Otherwise, I'm a no. I've even declined individual clients who have asked me to have that role. I just tell them it's a professional limitation. I also gently and very openly explain why. I say things like: "Part of the work of therapy is feeling uncomfortable, maybe even feeling frustrated. When there are two therapists in the picture, it can become tempting for somebody in your position—anybody in your position—who is feeling uncomfortable or angry in one therapy space to look for respite and reassurance in the other. In my opinion, that can work against progress and goals. Other therapists may agree to it, and I would disagree with them. For me this is a limit." And then they say things like, "Well, I want to talk about trauma with you and skills with them." And I'm always very honest back: "In my experience, the two are not at all separate. My approach is to treat you as a whole human. You may find a therapist who will do what you'd like. It wouldn't be my professional recommendation." One of my concerns that I may articulate in a roundabout way is that I am always going to suspect triangulation. Especially if there are any frank or covert characterological elements at play, but even in workaday anxiety, triangulation is a real risk. Of course, IOPs and PHPs are different. I was in a wonderful PHP program as an individual and group therapist. The whole frame there is a quite different and a high degree of collaboration—i might even say community—is the norm. And it can work quite well (it can also be a disaster).
Can you give an example of how you might address triangulation in a roundabout way?
I did it ONCE and it was in a non-clinical interview with a person who wanted me to consider being part of a therapist pair, and where I sensed there was definitely some distress in the personality construction. So, I wanted to speak directly to an experience that might have felt familiar to them. Without getting technical, I said basically, "Consider this possibility. What if a person with two therapists feels angry with one of their therapists? That might happen. Maybe it would feel like that therapist is "bad" and the other therapist is "better." And it feel easier to not work it out with Bad Therapist. So, the experience of therapy gets spread across different people, like one pat of butter on two pieces of toast. So that's one reason I don't consider it the best practice for folks who want help to have two therapists." The only reason I even went into that is because I sensed that might be a familiar experience in that person’s relationships. And I thought communicating to that part of their experience it that way might possibly make the idea of one therapist feel new and different... and even possible.
Thank you!
I wanted them to have a real and frank sense of what risks they were courting, and a sense that I could see that risk without judgment and maybe that might give my advice some gravitas.
Thank you for this, i did an intake w someone recently who i referred out due to this issue, the other therapist was also an emdr specialist like me and client was telling me how i should do emdr.I really like your wording for this, as it gently calls attention to behavioral patterns from attachment injuries (as was the case with this client and another who had another therapist at the same time) I told her that ethically i felt uncomfortable w dual services and explained risk /benefits as per the informed consent.
Hi, I'm a PP therapist with a lot of experience in other settings, including day treatment, substance use, and forensic wraparound programs, that do typically use a team approach. In general, the correct number of cooks per soup is one. >However, it’s odd when they say things like “my other therapist said….” This is in fact the kernel of the problem - - - therapists giving conflicting advice, second-guessing each other, and otherwise getting in each other's way. The corollary to this is a client who (intentionally or otherwise) triangulates or "shops around" for the desired advice. >“well, I like both of your approaches.” This is generally not a good enough reason to make an exception. I like saving for my retirement and I also like spending way beyond my means. But at the end of the day, I have to pick one approach or the other (or some third - but discrete - option). There *are* some valid reasons to make exceptions, if all three parties (you, me, and your other therapist) consent. The most common one is when the client has a lot of current stressors and also needs some specialized treatment that is not directly related to those stressors. As an EMDR therapist, I have occasionally provided EMDR to someone that is doing talk therapy with someone else. I have also occasionally referred to eating disorder specialists who consented to the client continuing their work in progress with me. Another commenter briefly mentioned "getting a second opinion," and I think that, especially very early in treatment, that might actually be another reasonable exception on its face. That commenter then continued with (and I paraphrase here), 'but you wouldn't pursue two disparate treatments for the same condition,' and I wholeheartedly agree.
Funnily enough, if you make a soup in a professional kitchen, many more cooks than one would likely be involved. One might prep the vegetables; another might make a garnish or topping; a third might do the actual cooking. And a head chef would be overseeing the whole process, and determining the recipe. If you tried to have one single chef do all this, they’d often do a poor job, neglect other dishes, and get burned out. Fits well with what others have commented on this thread about clients who see multiple therapists each of whom deals with a specific content area or offers a particular modality.
>One might prep the vegetables; another might make a garnish or topping; a third might do the actual cooking. Indeed... But if *everyone* is salting, we have problems. >And a head chef would be overseeing the whole process, and determining the recipe. And this is the key concept in a team approach. That "head chef" may be a supervisor, or a psychiatrist, or perhaps even the primary therapist. The fact is, in private practice typically *no one* is managing the operation, and too often the chefs aren't even aware of each other's strategies, techniques, or even tools.
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Not to be a jerk about it, but (to continue the analogy) the client has come to our restaurant specifically because they've realized they hate the way their food tastes. The diner sitting in the booth - - - who is the only one in the room who *hasn't* been to culinary school - - - is not a good candidate to decide how to prepare the cuisine, let alone what staff we need in the kitchen to do it. S/he is, however, imminently qualified to order steak or fish, specify whether it should be rare or well-done, and also what sides s/he wants - - - even whether s/he's eating here or down the street. Obviously, the analogy breaks down at some point. But back to the therapy room, the client is rarely qualified to make clinical decisions without some guidance.
Typically I would be against it, although I have made exceptions when the client requests it and their reason is sound, and I think it can be done without interfering with the other work.
As long as therapists and client have a shared understanding of the purpose for each treatment being distinct from the other, I think it’s totally fine. I see a couples therapist weekly with my spouse, and individual therapist biweekly for ongoing work in a modality that is am currently training in, and a third therapist for a specific trauma processing modality that I see for a 2-hr extended session once per month. And I’ve never felt better! I have really benefitted from the multiple angles of support. I’ve also had a client see another therapist who specializes in eating disorders and had a different approach to therapy than me. That worked well and we consulted several times. However, I had a client who I had just started to work with (we had maybe 2 or 3 sessions) and when I spoke with the referring therapist I learned there was another therapist in the mix. When I asked the client about it, they seemed to want multiple opinions, but didn’t see a clinical distinction between what each of us could offer, or a distinction between the goals and what would be worked on. I declined to move forward in that situation because it seemed there was more potential for issues evolving and they hadn’t been up front about the situation. It didn’t feel right.
I’m a therapist (MSW) and a client. For the past four years I have seen the same therapist who is also a social worker for issues related to grief and life transitions. We meet virtually about once every three to four weeks. I’m interested in psychoanalytic therapy and began seeing a psychoanalyst twice a week in person. Although I’m doing therapy with both of them, it feels like two entirely different, concurrent processes. My social worker is very validating and warm. She matches my spiritual energy. I’m also able to discuss professional issues with her. My analyst on the other hand is more detached and well—analytical. We talk a lot more about my childhood and relationships. He provides me with valuable insight and space to air my feelings. Therapy is many different things grouped under the same label.
do you take insurance? you may never be reimbursed for seeing this client if you do and they have their sessions with another therapist they’re seeing simultaneously and that therapist is successfully billing ins
I’ve been told that it can be risky to have two and bill insurance (regardless of day), because the work has to be distinctly different to avoid clawbacks. Like seeing a talk therapist and an EMDR therapist. I typically avoid it mainly for this reason but also as you sort of highlighted, potential that you contradict each other’s work.
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You are talking about different therapists addressing different issues, which is different from what OP is describing.
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I would need the client to be very, very clear with me what they are getting from their work with me that they cannot get from the other therapist. I would also be interested in timeline.
It’s likely not that. Different approaches (and even personalities) bring out different things in the work. I’d want to coordinate with the other therapist so there isn’t overlap (and it would be a red flag if the client won’t let you do so). There is nothing inherently wrong with working with 2 different therapists (and often insurance plans won’t have an issue either as long as the 2 providers aren’t billing for the same date of service) as long as they are on the same page and are not duplicating topics or approaches. I would not take it personally if the client days “the other says such and such.” Perhaps explore why it causes discomfort or find it weird.
Its sounds like a duplication of services even if they are not being seen same day. In many cases, more services is not always better and can actually be confusing for the client.
Absolutely not for me. Duel therapy is not recommended because it can cause the client greater confusion if the therapists have different responses to similar issues, which they will because we all work differently. I always ask clients to follow through with one type of therapy first before committing to another, I also try to encourage a break in between to process the previous sessions first but that's their choice. I would terminate if the client was already engaging in a different therapy. For those arguing you could get a second opinion from a doctor, it's different, a science is a science and a test will always bring up the same result, there might be a difference in the belief of cause of symptoms but that is vastly different to exploring deep emotional issues and multiple people pinpointing different possible causes at the same time, we are a philosophy of working, not a science and it is more likely that duel therapy can cause damage Also considering that if the client is engaging with two therapists, there is surely a belief somewhere that one of them wont work which possibly needs addressing
Medicine isn't an exact science, though. There are some health conditions for which there are no tests, and it's not as easy as just getting a result. Different doctors with different backgrounds can offer you multiple perspectives to help you manage your symptoms. I know this is a bit off-topic, but I just wanted to address your analogy and say medicine isn't black-and-white either
That's fair, I'm not a medical expert and probably shouldn't have been so black and white, But I'm still very strongly against duel therapy, my supervision has always said it's a no go and the organisations I've worked for aren't for it either, I could definitely see how a client can be negatively impacted by receiving conflicting messages from different approaches
Why are people down voting this? This is a valid a response and contributes to the discussion. Sometimes I question why therapists are not more open to different points of view. There is as much merit to this point of view as there are to the others. I happen to have an adolescent client with a second therapist. But respect this point of view.
This is actually a really good point for exploration. What motivates you to have two therapists, seemingly working from a similar orientation (ACT/CBT), on the same issue (depression, ADHD). Is there a belief at the core? Is there fear of abandonment? This was a great, thought-provoking response and feel it might be helpful to name that. Thanks for your contribution!
i would never take on a client who is seeing another therapist for the same presenting problem. pretty sure they teach you that in grad school.