More therapists, more better!

January 30, 2010 6:36 PM

Shopping for not just one, but two therapists. I think. Best way to go about this?

It's time to bite the bullet and start counseling for my own issues (anxiety, depression, pretty constant bad mood). My partner of 2-1/2 years and I have also decided we need to go to counseling. Some of our relationship troubles are undoubtedly caused by my epic foul moods (which I need to and am committed to working on; see above), but we have some other things to work on too.

Our coverage is through my insurance. There are three in-network therapists locally who are taking new clients. It seems inappropriate or unfair for my personal counselor and our couple's counselor to be the same person. (I'm not sure who it would be unfair to -- me or my SO -- but it sure seems like it would end up screwing someone.)

Am I right in thinking that we need two different people? And any advice on how to go about asking questions to get the right fit for me/us? I guess I'm not sure even how to phrase my real question -- it just seems weird that we'll be picking two of the only three we can see, and I feel like I may bet setting someone up for a conflict of interest. I mean, what if the one I pick for myself is better suited to see us as a couple? If I go to him/her three times, and then *we* start going to him/her because it's a better fit, doesn't that skew things a bit?

[Oh hey, look, there's the anxiety I was telling you about!]

Basically: Any advice on how to best navigate this situation, and how to determine who's the best therapist for the two jobs at hand here? And as for me, I'll be in the position of having to get comfortable with two new counselors. Does it maybe make more sense to space this out a little bit?

posted by anonymous to human relations (8 answers total)

Couples counselors sometimes want to see each part of the couple individually; no need for two separate counselors, I'd think. Else you would get confused about what you said to which counselor.
posted by dfriedman at 7:17 PM on January 30, 2010

You may be right about needing two therapists, but as an anecdotal point I will tell you that my partner and I did couples counseling at the same time I was working on some serious anxiety issues, and with the same therapist--in fact, my anxiety emerged as an issue during our couples sessions, and there was a period of time when it was more like I was doing therapy with him there in support, because our couple issues and my individual issues were so intertwined. I don't know how typical or "right" that was but it worked great for us. The therapist may be able to help you decide how best to proceed; she or he has probably worked with couples in similar circumstances before. So, to start with, I'd ramp down your anxiety and think about figuring out whether ONE of those three therapists is someone you and your partner feel comfortable talking to.

Good luck.
posted by not that girl at 7:47 PM on January 30, 2010

Else you would get confused about what you said to which counselor.

Having been in both individual and couples counseling at the same time, with two different counselors... I would be quite surprised if this were an issue. The ways in which I discussed m issues with my individual counselor were quite different than the ways in which I discussed them with the couples counselor, particularly given that my partner was sitting right there.

To the asker: I think dealing with both your personal issues and your relationship issues at the same time makes sense. Personally, I found that doing both at once made each more effective.

One question, though: Are you dead-set on going through your insurance company? IME mental health benefits are sufficiently paltry as to not make it worthwhile; you might want to think (if you haven't already) about paying out of pocket. At the very least, it would probably broaden the range of therapists you'd have to choose from.
posted by asterix at 9:49 PM on January 30, 2010

Couples counselors sometimes want to see each part of the couple individually; no need for two separate counselors, I'd think. Else you would get confused about what you said to which counselor.

No! It's generally considered an ethical conflict of interest for one therapist to do individual therapy with one partner in a couple (that said, a couples therapist might want to spend some individual time with each partner, but it's not individual treatment, it's adjunct to the couples therapy specifically). Seriously, therapists lose their licenses for doing weird stuff related to treating an individual and couple concurrently. It really is inappropriate and, as you said, OP--unfair. Which is counter to the goals of couples treatment in the first place, isn't it?

It might be easier to start the couples part first, then seek out another therapist for yourself. It might help you get some focus on the goals you'd like to set, and that will save you time/money in the individual therapy.
posted by so_gracefully at 11:25 PM on January 30, 2010 [1 favorite]

No! It's generally considered an ethical conflict of interest for one therapist to do individual therapy with one partner in a couple

I don't think this is accurate. I have a friend who is using her individual therapist (who she has been seeing for years) for marital counseling as well, occasionally. We're actually in group therapy as well, and the group leader, who is a phD and quite concerned with ethics generally hasn't indicated that this is a problem.

My understanding of couple's counseling (I've never been in it, but my dad is a phD who specializes in couples & we've talked quite extensively) is that the therapist is never on one person's side, even if the therapist might privately think one person is being more reasonable. The therapists job is not really to help the couple come to a solution on a concrete issue; it's to help the couple communicate with each other, so the couple can come to a solution. In general, the main goal of the therapy is often to help the couple communicate effectively. So, seeing one person in individual therapy is less of a conflict of interest than one might think - the therapist isn't then more sympathetic to one side or the other in a couple's session, since he or she isn't taking any sides at all.


In any case - to the original poster - I suggest calling all three therapists and telling them that you're looking for both an individual therapist and a therapist for you and your SO. You may find that one or more of the specializes in couples, or anxiety & depression, or perhaps one of them works primarily with adolescents and isn't really an option. You'll probably get a feel for whether you have a connection with them over the phone, at least to some degree. If you like some of them, you can ask what they think of working with both you, individually, and both of you, together, and if they would see a conflict of interest. Then, especially since there are so few, you can schedule appointment with any of them you're interested in, just to try them out for a session.
posted by insectosaurus at 8:06 AM on January 31, 2010

insectosaurus, some therapists might be fine with it, but that doesn't mean it's a good decision on their part.

Here is the basis for the idea that it's a poor choice to see a couple and one person from the couple: essentially, if the individual person says something in an individual session and the therapist forgets that it was in individual therapy, and repeats it in couples therapy, that's a violation of one of the most basic/universal ethical codes in the psychotherapy profession, breaking confidentiality:

2.2 Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.
(American Association for Marriage and Family Therapy Code of Ethics)

There are therapists (even Ph.Ds, yes) who lose their licenses because they share information that one partner has shared in individual treatment with the other partner (diagnoses, reports of things Partner #1 said, etc.).

Not to mention the power and relationship dynamics that are unavoidably involved, and the potential for being subpoenaed in divorce proceedings (which would also break even more ethics codes, if the therapist testified against one partner or another). I think it might be different if the couple lives in an extremely rural area where there is only one mental health care provider available within a reasonable traveling distance, but otherwise, it's just not a good standard of care.
posted by so_gracefully at 10:53 AM on January 31, 2010

Of course if therapist who saw both an individual & that person as part of a couple s/he couldn't reveal anything the person said in individual therapy; I just took that as a given. Some therapists might prefer not to put themselves in the kind of situation where they would want to reveal something, or could accidentally reveal something, even, but some (ethical) therapists are confident in their ability to both remember what was said where and keep silent where appropriate.
posted by insectosaurus at 2:28 PM on January 31, 2010

I would be a lot more concerned about (as I mentioned) the unavoidable issue of power and relational dynamics involved. (I was invoking the ethics codes because I wanted to mention that people have actually lost their ability to practice because of the clumsy/stupid ways they worked in that kind of situation.) It just feels wrong to me in a very instinctual way, and while I realize that not all therapists work in a way that takes social and relational context into account, I think those therapists are missing the mark BY FAR in couples work if they ignore those factors.
posted by so_gracefully at 11:38 PM on February 3, 2010