“Why can’t I see two therapists?”

Some clients believe that by seeking guidance from multiple therapists they can benefit from different perspectives and therapeutic approaches. For instance, someone might seek a therapist specializing in Dialectical Behavior Therapy (DBT), while hoping to keep their current therapist who is more focused on simply providing emotional support. This is a scenario we encounter regularly with new clients coming into our DBT program. While seeing two therapist may seem appealing, it’s crucial to understand why this is usually a bad idea.

We generally won’t work with clients that do not plan to terminate or pause treatment with their current therapist. The good news: DBT is time limited, and once a client reaches their DBT goals they are free to return to their previous therapist. DBT usually requires a commitment of one year, and during that year clients can see some incredible changes.

This is not a DBT specific rule, but a rule most therapists tend to follow. Read on to learn some of the reasons why.

Building a Strong Therapeutic Relationship

One of the foundational principles of effective therapy is the establishment of a strong working relationship between the therapist and the client. This relationship serves as the cornerstone upon which all therapeutic work is built. When you work with a single therapist you have the opportunity to develop a deep and meaningful connection over time. A single therapist gets to know you on a personal level, understanding your unique experiences, challenges, and goals. They become intimately familiar with your history, allowing them to tailor their approach to your specific needs. This personalized connection fosters trust, openness, and a safe space for you to explore your thoughts and emotions.

In contrast, when you opt for two therapists, you risk diluting the strength of both relationships. It can be challenging to establish the same level of trust and intimacy with two therapists simultaneously. Clients may find themselves divided between the two professionals, hindering the development of a close therapeutic bond. It can be hard not to pick favorites or to prefer the therapist that is more supportive and less change-focused (even when some focus on change would be more effective). As a result, the effectiveness of the therapeutic process may be compromised.

The Importance of Consistency in Treatment

Every individual seeking therapy has a unique set of circumstances and objectives. In DBT, your therapist creates a treatment plan tailored specifically to your needs and goals. They draw from their expertise in DBT to design a plan that addresses your concerns comprehensively. This personalized approach ensures that you receive focused and cohesive care. Your therapist can adjust and refine the treatment plan as you progress, adapting it to your changing needs and goals as you work together to track your progress and make necessary adjustments.

Having two therapists leads to the fragmentation of your treatment plan. When individuals work with two therapists, they often do so with the expectation that they will receive different perspectives and strategies from each therapist. While some may think this is advantage, it almost always leads to conflicts and confusion. Each therapist will have different approaches and strategies, which will likely conflict in ways that are not productive, and may even be harmful. Managing and coordinating multiple treatment plans can become confusing, hindering your progress rather than enhancing it.

Conflicting Strategies: Acceptance and Change in DBT

DBT therapists are supportive and accepting of who their clients are today, and they try to help their clients learn to accept themselves, their emotions, and their present circumstances without judgement. At the same time, they encourage their clients to engage in the hard work necessary to bring about significant and lasting change in their lives.

Some forms of therapy are purely supportive, offering a kind and validating space for clients to share their thoughts and feelings without judgement. Often, clients seeking DBT have a history of receiving supportive therapy. They have decided to seek out DBT because they are ready to make some more significant changes in their life, but they are sometimes not ready to give up their supportive therapist.

Unfortunately, this kind of therapy often conflicts with the change-focused work in DBT. DBT therapists often ask clients to engage in the difficult work. If such a client is also seeing a supportive therapist there is the risk the supportive therapist will keep the client “stuck” by unintentionally sending the message that the client does not need to work toward change. This can prevent clients from engaging in the difficult work required to develop new strategies or learn new ways of managing emotions by shifting the blame to the environment (over which we have little control) from the client themselves.

DBT therapists will often encourage clients to look at the role they play in the conflicts they have with others, while a supportive therapist may be more likely to unintentionally send the message that the conflict in their lives is primarily the fault of others: “You’re spouse is so difficult, and you’re trying so hard!” This can prevent clients from engaging in the difficult work required to improve the quality of their relationships.

Dilution of Focus and Resources

Effective therapy relies on setting clear goals and making consistent progress towards achieving them. A single therapist can work with you to establish well-defined objectives and help you track your advancements. They can also adapt your treatment plan as needed to ensure you stay on course.

With two therapists, the division of focus can hinder your progress. You may struggle to maintain a cohesive therapeutic narrative when working with two therapists simultaneously. Progress can become fragmented, with each therapist addressing different aspects of your concerns. This fragmentation can lead to a lack of clarity regarding your overall therapeutic journey and hinder your ability to make meaningful strides towards your goals.

Furthermore, when your focus is divided between two therapists, you may not have enough time or energy to fully engage in the self-reflection and homework assignments that are often part of therapy. These activities are essential for personal growth and skill-building, and their effectiveness may be compromised in a dual therapy scenario.

The Exception: Coordinated Care

There are some situations where seeing more than one provider makes clinical sense — but the key word is coordinated. A client in DBT might also see a psychiatrist for medication management, or a nutritionist for an eating disorder, or attend a support group. These are different from having two individual therapists, because each provider has a distinct and non-overlapping role.

In comprehensive DBT, this kind of coordinated care is built into the model. Your DBT therapist, your skills group leader, and any other providers communicate with each other (with your permission) to ensure everyone is working in the same direction. The consultation team is part of this structure — therapists supporting each other behind the scenes to stay effective and consistent.

The problem arises specifically when a client has two individual therapists doing similar work — providing emotional processing, setting treatment goals, giving advice about relationships and coping strategies. When that happens, the risks described above become almost unavoidable.

What About After DBT?

Many clients who come to us with an existing therapist are understandably attached to that relationship. DBT is time-limited — typically about a year — and after completing the program, clients are free to return to their previous therapist if they choose. Some do, and they often find that the skills they learned in DBT make their previous therapy more productive. Others find that the growth they experienced in DBT has changed what they need from therapy, and they decide to move in a new direction.

Either way, the temporary pause in the previous therapeutic relationship is almost always worth the gains that come from committing fully to DBT during the treatment period.

Conclusion

Seeing two therapists presents significant drawbacks and challenges. Working with a single therapist offers the advantages of building a strong therapeutic relationship, receiving personalized treatment plans, and maintaining consistency and trust. These elements are absolutely crucial for effective therapy and will almost certainly be compromised in a dual-therapist scenario.

Moreover, the potential for conflicts, miscommunication, and the dilution of focus and resources in dual therapy can lead to client confusion and stress, ultimately hindering progress. This are special risks when trying to maintain a relationship with a supportive therapist while also trying to make the sorts of changes a DBT therapist would encourage.