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Seeing More Than One Therapist

I have a question about seeing therapists. I have read and have been told by friends who have had this come up in therapy that it is not ok to see more than one therapist. I understand in principle, but I have a question. I saw a psychologist off and on for 10 years who was very helpful to me through a number of issues I dealt with. He was very supportive, which I needed, and he knows me very well. I felt i had gone as far as I could with him on problems I was haveing with ADHD problems and problems with schooling. I felt bad for him that I just kept failing to improve. I was referred by my psychiatrist to a cognitive psychologist, and he was helpful to some extent in a different and complementary way.

I have not seen the other psychologist for over a year, but have overwhelming feelings related to older issues that I feel the 1st psychologist would be more helpful for. I am considering going back and talking to him. The cognitive psychologist asked about whether I was still seeing the previous psychologist when I started with him, which I wasn’t. In this sort of situation, is there any good reason why it would be inappropriate to go back and talk with psychologist #1 for support with my current issue, about which he is very well informed already, and leave open the possibility of seeking more help with the cognitive issues at some point with the other guy?

Right now, I have held off on more appts. with #2 due to a new deductible with the new year and tight finances, but I am seriously depressed about the old issues at the moment. Also, I just got a letter stating that my insurance will no longer cover #2 because he is a “service extender” and that is no longer covered. How does that work?? I might be willing to pay cash without it going toward my deductible at some point, but that would be much harder.

Thanks for writing about this question. I think it is an important one.

The idea of seeing one therapist has been around for a long time, mostly so there would not be conflicting feedback, or more deeper concerns with transference, or the possibility that the relationship usually needed to make the changes in your life would be thwarted by a second therapist.

But the thinking and the practice of this has changed radically in the last 2 decades. As an example twelve-step programs and therapy were estranged, now they are more likely to be seen as mutually supportive interventions. Couples therapy needs to be done with a different therapist than the individual, group work is separate from couple and individual, and trauma interventions may require specific treatment.

Therapy has also morphed into a very different form than it was before managed care and other insurance matters. Therapy can have a highly specific focus, with specifically trained therapists who work with you on specific problems. I regularly invite my clients to see another specialist with a particularly different skill (such as EMDR) when they need it, and other therapists will send their clients to me when they need my specialty (For instance, group therapy).

As far as the “service extender” status this is something no clinician I know understands. The core feature seems to be the insurance companies use this phrase to suggest a duplication of services. When this has happened I know the insured and the clinicians have written to substantiate the fact that it is not a duplication, but a different service. When I have to do this for the purpose of explaining the difference between individual and group therapy the insurance companies sometimes change their position. My suggestion is to challenge the insurance company decision if you feel strongly that the two therapies are different. The worst that can happen is the insurance company will deny it.

So the short answer to your question is yes, you can. The one thing I would suggest is not to keep it a secret from either. Be clear and upfront about what you are doing and why. You don’t want the process of getting help run the risk of you feeling bad.

Wishing you patience and peace,
Dr. Dan

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