June 25, 2014
“Can people have two therapists?”
This question was put to me by a client during the final minutes of a session. I thought about it for a few seconds and said “I think that deserves a conversation, can we talk about it next time?” I told her that the short answer is that it’s not usually advised, but I didn’t want to just say that without thinking it through. I wanted to know what she’s looking for. We agreed to pick up on it next session.
After that, it weighed on my mind. I know from ethics workshops and discussions with colleagues that most therapists would advise against it. I know for myself that I would only be comfortable in very specific circumstances. Perhaps if our modalities were clearly defined and very different, such as if she wanted to see a Reiki practioner, an EMDR specialist or a health counselor for nutrition. But to have two “talk therapists”, I doubt that would be the best way a person is served – but why not?
Turns out it’s pretty easy to find resources and articles that say no, it’s not recommended. The reasons given (often by therapists) include splitting, conflicting treatment plans, creating secrets (especially if they aren’t aware of each other or aren’t in communication). One blog called Jung at Heart has some good points, and interesting responses in the comments section.
I saw a comment on another site by a client who wants to have two, saying if a therapist insists on being 'the only one', “It seems to me this keeps the whole therapy-as-mystery and power imbalance going". That doesn't sound like a good experience of therapy, but it's not a good therapist's agenda.
I found other people who advocate having two therapists as a way to get more perspectives and advice, to have more to choose from. This might be true, but could get confusing, as it could dilute each therapist’s ability to create a plan, goals and accountability with that client.
As I try to be open to the idea and imagine scenarios and possibilities, I do keep returning to the place of “probably not the best idea”. Though I'm skeptical, I wanted to honor her question with a discussion, and explore the needs that are behind it.
I considered why she asked… the thought crossed my mind “I’m not doing enough, I’m not providing enough or giving her what she wants”. The implication from someone who asks about two could be that they’re looking for more from their sessions. But it doesn’t mean I was doing a terrible job, and I don’t think she meant to indicate that. Her tone seemed to have more to do with feeling impatient for change – not just in therapy, but in her life. (She is a very talented young woman who is involved in several fields at once, and had some success in each area, but wasn't fulfilled. She'd like to be a superstar.) Perhaps her desire to have multiple therapists mirrored that sense of needing it all to happen at once.
I think the concerns about “splitting” are valid – it could to set up a “you said/they said” dynamic -- if one therapist’s suggestion or plan is somehow at odds with the other therapist’s recommendation, it would set them up against each other – a classic splitting of parents, being recreated. Even if therapists had permission to speak to each other to try coordinating care, it's probably not realistic to have them in contact on a regular basis. Would the client share what issues they were speaking about in other sessions? If not, what would be missed?
It doesn't sound realistic to “focus on separate issues with each one”, as a comment on an article suggested - in my experience, people are not that compartmentalized. Issues such as happiness in the relationship, fulfillment at work, time management and self esteem or family history are often intertwined.
When goal setting and homework is planned, would the client be able to manage the extra "assignments"?
One therapist posted in a comments section on this topic that “Even if you have six therapists you still won't get every possible perspective, you'll inevitably be missing out on insights that someone else could offer you”, which I think is true. If someone has a desire to get other viewpoints, this quest can actually get in the way of making clear choices. People can get caught up in "information-gathering" and actually delay their choices that way.
So, I raised the subject at the beginning of the next session, and thanked her for asking a compelling question. She responded that she'd realized it's not the way she wants to do things. We used it as an opportunity to talk about our process and what she wanted to get out of our time together. Having two therapists was no longer on her agenda, but it helped bring new considerations in our session, and was also a thought-provoking idea for my practice.
I welcome responses and ideas - would it ever be useful to have two (or more!) therapists?