Therapist Collaboration: When is It A Good Idea & How is It Useful?

Matthew Cuddeback LCSW

There is a complex area that often arises requiring therapists to carefully consider how to proceed while advocating for our clients, respecting their wishes, and protecting their therapeutic experience, that is professional collaboration. Whether it is collaborating with another therapist you may be meeting with, a former provider, or collaborating with a current provider who is prescribing medication it is something that should be given a lot of thought. Let’s talk about what to consider as a client and what your therapist is thinking about when considering collaborating.

The area I tend to start with is the reason for the request. Often people are requesting their therapist collaborates with their psychiatrist or previous provider, and the first thing I ask is for the reason behind this request, I like to ask, “What do you think I can learn from them that I might not be able to learn from you?” I often ask this because I typically find it more helpful to get information about you, from you. Often people think that maybe someone else can fill in the picture and while this definitely can be true, I would rather learn that thing from working with you instead of learning it second hand. Sometimes people feel pressured to request providers collaborate, and it can be a profoundly helpful process, however, it can set up a lot of issues if you feel you are forced to do this.

After discussing the reason, I like to discuss the costs and benefits of collaboration. This is where I share my perspective on the process, which is very much something that each therapist may approach and think about very differently. I explain how sometimes this can lead to a messier relationship, if you know your psychiatrist and I, as your therapist, are discussing your care and I mention something that you believe suggests we are somehow conspiring against you that can be very damaging to our rapport and trust can be hard to repair. It’s also possible that I hear something or learn something that would have been much more useful to hear from you. However, sometimes it is amazingly helpful to collaborate. Perhaps your psychiatrist tells me they are concerned about side effects of a new medication, I can report to you and your psychiatrist what I am seeing in each session. If you start a new medication and I notice your affect has become blunted and this is a drastic change, we can report this to the psychiatrist. Maybe we can work through diagnoses, or I can advocate for you to hopefully help your psychiatrist understand why you want this or don’t want that.

Lastly, I discuss confidentiality and the role it plays in collaboration. First, a Release of Information is needed. Then I explain what I will and will not be discussing, I tell clients that I will remain focused on doing what we are intending to do with the collaboration and nothing more. If we are discussing a new medication, I will not be talking about the dream you had that you were embarrassed about. If it is about a diagnosis, we don’t need to necessarily discuss your marijuana use. Collaborations should be very targeted and specific, and I will always discuss with the client what I will discuss before I do and ask if there is anything you do not want me to discuss.

There are many reasons why it can be extremely helpful to collaborate and many why not. So, discuss it, and ask your therapist to explain to you how they engage in this process and why it could be helpful or harmful. It is always appropriate to ask your therapist to collaborate, and it is also often appropriate to ask them not to. Collaboration can be a very helpful and powerful tool but should be done with careful consideration.