Leading Edge Psychotherapy: The psychotherapy team

A psychotherapy team involves multiple therapists who meet successively with the same client for individual therapy. Therapy teams have begun to emerge, in varying degrees, in a few state-of-the-art addiction treatment facilities. Their emergence may have occurred somewhat serendipitously but as Pasteur remarked “chance favors the prepared mind.”

To my mind the experience with the team format highlights the illusion of believing that a client exists as such and that the client’s problems or difficulties exist as such. By “as such” I am referring to the idea that the client and his or her difficulties can be apprehended or discovered as they “really” are, objectively, in pretty much the same way that a physician (with the help of lab tests, etc.) can detect/diagnosis an established medical disease, a chemist can analyze the chemical composition of a substance, an ordinary member of our society can identify common artifacts like televisions and cars, and so on. What the team format brings to the fore is that who the client “is” and what his or her problems are cannot really be divorced from who the client is talking to and why/under what conditions they are talking.

Most of the clinical literature it seems to me postulates a client and his or her problems as existing (somewhere) apart from and beyond conversations with a specific interlocutor. It is harder to maintain this idea when the same client is simultaneously having conversations with different therapists. It’s not that for example a client describes a drug abuse problem to one therapist and denies it to another, it’s rather that what the client says to one therapist about what the drug problem means, what’s relevant to understanding it, and so on changes somewhat as the client meets with different therapists. This is no more mysterious than understanding why in everyday life we all say/tell different things to different people—the audience and social interaction change as we converse with different people.

If we are going to talk about something as complex and multifaceted as personal experience, the interests and responses of the interlocutor really matter as the conversation develops. A conversation does not belong to just one person. Everything the therapist says and more broadly his or her total manner of being and interacting affect the social interaction at hand, and thus what the client says, how he or she says it, and what he or she does not say. This is obvious enough from the perspective of everyday social experience but it conflicts with a deep conviction in clinical psychology that the client has an essence (somewhere) that is independent of the present social situation. Psychological testing is based on the supposition that a non-social or socially neutral situation can be contrived for the purpose of detecting the individual’s essence. In a rather conspicuous way this effort is self-contradictory because instead of exploring what is uniquely individual about the person the point of testing is to compare the person to others on a pre-established set of questions and response possibilities.

The hard part to keep in mind is that except for superficialities when the client talks about personal history there are no facts to report (contrast the client reporting where he or she grew up to relating the emotional atmosphere of the home). The client (all of us) have an unarticulated felt sense of a topic like the emotional atmosphere of the home growing up, but there are many possible ways to express it and features to focus on, and the point I am emphasizing here is that what the client actually says to a specific person on a specific occasion is not independent of the other person’s interests, responses, and so on. The team format, again, makes this point conspicuous.

The client in the intensive team format situation covers so much more ground—by virtue of meeting with multiple therapists—than with a single therapist that it is hard to think that the single therapist format can compete with the team format. Of course the team format is unavoidably expensive, but even in a short period a great deal can be accomplished.

David Jacobs, Ph.D., is a senior psychologist at Practical Recovery.  His research focuses on how traditional diagnosis and psychiatric medication can impede the psychotherapy relationship.