Why Can't I Have More Than One Therapist?

Question: Why Can't I Have More Than One Therapist?

I was recently diagnosed with borderline personality disorder. Although I have been in therapy for a while, I want to see an additional therapist to specifically target my personality disorder. My current therapist and I focus on other issues, but I do not want to ignore my personality disorder. I contacted a therapist, but he refused to take on a client who was already engaged in therapy with another therapist at the same time. I do not want to quit my current therapist, but I do not want to ignore my personality disorder. What would you recommend I do?

Answer:

Generally speaking, having more than one therapist for individual therapy is not a good idea and can actually do more harm than good. It is a good idea, for anyone questioning her current treatment, to talk to her existing therapist about treatment concerns, including treatment for personality disorders.

It is important to remember that a personality disorder refers to a collection of symptoms whose roots have been engrained in your personality as it developed. Due to the nature of a personality disorder, it is not really possible to separate everything out into different aspects, as they are all intertwined in a giant tangle. Everything is impacted by a person’s personality. In addition, a newly diagnosed personality disorder, does not mean that it is a newly developed disorder.

When you see more than one therapist, it can feel as if they are supplying conflicting information (even when they are not). The client may feel as if he is in the middle and being pulled in different directions by the therapists, and/or it can set up a dynamic where the BP plays the therapists against each other.

There are treatment programs, such as dialectical behavioral therapy (DBT), where the programs incorporate more than one therapist with each client. These programs successfully use a treatment team approach, where the clinicians’ roles are clearly defined and the program is structured in such a way that the use of additional support clinicians provides maximum benefit to the client. However, these are structured programs where the therapists are specifically trained to work in a treatment team; these programs cannot be created simply by adding more therapists to an existing course of therapy.

There also are occasional situations when someone with BPD may have more than one therapist other than the DBT team model. This may occur when there is a specific symptom focused (cognitive behavioral) treatment for co-occurring conditions, such as obsessive compulsive disorder or an eating disorder, that is not being tackled by the more personality-based aspects of a treatment. In this case, it is important for ongoing open communication between therapists to prevent treatment splits that can tend to occur among BPs.

If, in the course of treatment, a therapist diagnoses a person with a personality disorder, then she most likely believes that she is competent to treat it. Otherwise a therapist who diagnosed a personality disorder would provide referrals to another therapist and end her sessions with the client. Although it is not easy, it is important that clients discuss any treatment concerns in therapy sessions, including asking how the therapist plans to treat the personality disorder.