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Is There Room on the Therapy Couch for Friends?

Health: We've all been referred to professionals by pals or family. But a psychologist? Many say they can stay impartial even if they've already heard the other side.


When Cheryl was shopping for a therapist 10 years ago, she found one through a friend. She wound up liking the psychologist so much that she sent her husband, her mother and several close friends to see him.

"Now we're all seeing him. I have to admit it feels a little incestuous at times," says Cheryl, 38, a computer systems director from Valencia.

We share our doctors, our dentists, our hair stylists and our real estate agents with our friends and family, so it should come as no surprise that we also share our shrinks.

But should we?

It's human nature to take a referral from someone we know and trust rather than blindly pluck a name and number from the Yellow Pages. But there is a big difference between sharing a tennis pro and a mind pro.

Well, isn't there?

Some critics contend that the practice is fraught with peril for both the patient and the therapist.

"It's the front end of a slippery slope," warns psychologist Gary Schoener, executive director of the Walk-In Counseling Center in Minneapolis, who lectures throughout the country on ethical issues surrounding psychology.

"Problematic," is the way Dr. Richard S. Epstein, a Bethesda, Md., psychiatrist describes it. He has pondered the matter at length during his tenure as chairman of the Ethics Committee of the American Psychiatric Assn. and doesn't accept patient referrals.

Schoener and Epstein agree that separately counseling a pair of friends or family members probably isn't a problem if the two don't talk about each other in therapy. But chances are, they eventually will. And therein lies the rub.

"What often happens is that a conflict arises between the first and second patient and the doctor is caught in the middle, and it screws up the relationship between all three," Epstein says.

The therapist may squirm because he or she is "bound to advocate and help both patients" with differing goals, Epstein says. The patient, meanwhile, may feel that the therapist's loyalty is unfairly divided.

One Westchester woman, who requested anonymity, knows how this feels. She is being treated by her husband's psychiatrist and says it can be frustrating.

"Because the doctor has more of a history with my husband, I feel like he almost always takes my husband's side when I bring up one of our problems," she says.

For this reason and others, she is considering getting a new therapist.


There's nothing in a therapist's code of ethics against seeing patients who know each other--whether his or her name is followed by the initials M.D., PhD or MFCC. In fact, in the case of some psychologists and psychiatrists, a good chunk of their business comes from client referrals.

The practice is "very common," Epstein says, basing this on his general observations and a study published in 1992 in which 2,500 psychiatrists were surveyed. One question: "Have you accepted for treatment individuals known to be referred by a current or former patient?" Of 532 respondents, 83.8% answered yes.

During the 1960s, Epstein says, there was a flurry of discussion over sharing psychiatrists in the professional literature. But nowadays, "There are so many other problems, like managed care, that most psychiatrists don't think it is a big problem."

And neither do some of their patients, who might find themselves in the position of vying for the therapist's attention, thereby creating a sibling-like rivalry.

Or a situation can be further complicated if a couple divorces--or if two friends have a severe falling out.

"Somebody's got to go, but who?" Schoener asks.

And then there is the potentially mind-boggling issue of keeping track of which patient said what.

Let's say a psychologist is separately seeing three sisters and family secrets are flying.

"Can the therapist honestly keep clear in his head who he got what information from, and not slip and reveal something he shouldn't to another patient?" Schoener asks.

"The classic case is the patient who says he doesn't drink, then his friend comes in and says he's a fall-down drunk. How can you not react to that? The therapist is either going to start acting weird with the first patient or spill the beans."


Cheryl worries that her psychologist could get confused and say something that he shouldn't.

"Sometimes I won't tell him things about my mother just in case he makes a mistake and tells her."

It's not that her psychologist isn't ethical. It's just that he's human.

"How can anyone keep all these conversations straight?" Cheryl asks. "He reassures me that he can, but I guess I can't even be 100% guaranteed in my mind."

Helene C. Parker, a Newport Beach psychotherapist who individually treats as many as three or four family members, dismisses such worries about breaches. "There is no chance that I would ever tell a secret."

Sometimes one patient may even "fish" for information about another one, hoping Parker will reveal a juicy tidbit. But, she says, "I just keep repeating, 'I am a neutral party.' I make it clear that I cannot be manipulated."

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