Seeing both partners in a couple

[Attending1985]

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Do you guys see significant others in your practice? It’s happened to me inadvertently on rare occasions. On those occasions, it’s been OK because the relationship between them has been pretty functional. I was recently asked to see if the significant other of one of my patients where she cites him as the source of a lot of of her distress and I said no for this reason. Was wondering how others handle this?

 

[comp1]

This sounds like a bad idea if by "see" you mean take on a partner as a patient or anything beyond getting collateral on your current patient. In that case, I'd refer to someone else and explain the importance of not having dual relationships in treatment. Just the fact that original patient was asking makes me concerned and may indicate she needs some psychoeducation.

 

[Mad Jack]

I 100% refuse to see both as patients, creates way too many potential issues. Generally I'll provide recommendations for other psychiatrists in the area

 

[romanticscience]

I sometimes will see both for medication-oriented treatment or one for therapy and the other for medication. It's hard to find quality professionals sometimes. However, it backfired the other day when fidelity issues arose; I then referred the partner to another provider.

 

[comp1]

I'd recommend one member doing telehealth over one provider seeing two members of a couple outside a formal couple's counseling framework if there's no nobody else local. No shortage of telehealth. That couple's counseling framework exists for a reason. I'm not at all confident that there is a meaningful distinction between medication management and psychotherapy in this context.

 

[Merovinge]

This falls under the old adage that there are no called strikes in investing (for those that don't watch baseball, this means you absolutely don't need to swing at (invest) in every sector or thing that comes along - e.g. bitcoin, real estate, gold, etc).

There is just no reason to put yourself in this kind of position when you don't have to. Almost nothing to gain and plenty to lose.

 

[Stagg737]

Generally agree that this is a bad idea. I occasionally do it because I am a consult clinic for half a state where the goal is to see patients once or a couple times and then send them back to PCP where there isn't anyone else. However, if I had a typical outpatient continuity clinic I would absolutely not do this. The dynamic is messy, and often times you get very conflicting or discordant views of a relationship that could (but shouldn't) effect how you approach a patient.

 

[Sushirolls]

If only doing meds and supportive therapy; and alerted up front to have separate therapist; then yes. And I have done this.

If doing a more structured therapy modality beyond supportive therapy, don't take on the 2nd person.

 

[Stagg737]

If only doing meds and supportive therapy; and alerted up front to have separate therapist; then yes. And I have done this.

If doing a more structured therapy modality beyond supportive therapy, don't take on the 2nd person.

I would still say this is a bad idea much of the time. You never know what a patient is going to bring up about their SO or how they might get you involved if they know you're seeing them. Without getting into too many details I have had 2 such situations in which relatives/exes were seeing me and things came up that caused significant problems/potential major problems.

 

[Sushirolls]

I haven't had any issues, and can't foresee where there would be.

As you describe having had 2 situations we'd all need some modicum of details to understand. Perhaps my current approach may be flawed based on what you might 'case study'

 

[Stagg737]

I haven't had any issues, and can't foresee where there would be.

As you describe having had 2 situations we'd all need some modicum of details to understand. Perhaps my current approach may be flawed based on what you might 'case study'

Father/son situation where son was stealing from parents for drug money. Many questions about substance use by parent(s) as well as son trying to manipulate the situation. Significantly interfered with therapeutic rapport of both individuals as I frequently had to tell each, "I can't discuss that" in regards to questions which subesequently caused further interpersonal problems due to each of them being upset that they were clearly hiding things from each other that they were telling me.

The other was/is involving two exes who didn't know the others are/were seeing me. One accused the other of attempted murder. Won't go further into it, but you can imagine how this could cause issues. I didn't even know they were exes until my MA informed me that they were, so that was a fun surprise.

I actually forgot that I also had a third couple I saw (first one, then the other). Saw them after they witnessed a friend kill themself. Saw him first for PTSD and he did really well, got a lot better. She was in therapy with someone and getting treatment herself at the time. He thought things were improving really well and on the right track. Sent him back to PCP and a couple months later saw her for med recs for PTSD. She said things were awful and that she was struggling horribly with PTSD. Per her, he wasn't aware of how horrible her PTSD was and she was hiding it and didn't want to let him know. Problem was she felt so horrible she was considering leaving him (they were engaged) because she didn't want to be with anyone. Not really a major issue in terms of practice, just sucked knowing that this guy who was a legit great guy (even per her) was going to get blind-sided because she didn't want to keep up with the MH care she needed. Tried to encourage her to continue with care, talk to him, and even do couples counseling (which he was 100% willing to do) but she just didn't want to. No idea what happened with them.

 

[FlowRate]

Thankfully the few spouses and children I've had have all been functioning well in their relationships, so it was a non-issue. I don't really get advance notice for who I'm going to see and sometimes people even have different last names, so I don't realize they're married to another patient of mine. Often the first I realize is when the patient says "since you know my husband X" or "my mom Y" but that's never been a probing statement. Nevertheless, I usually just say my blanket behavior is to never confirm or deny whether I see anyone else they name and never communicate any implied familiarity. I agree that if the relationship dynamics were more fraught, I'd look to transfer to another psychiatrist in the practice.

 

[Stagg737]

Thankfully the few spouses and children I've had have all been functioning well in their relationships, so it was a non-issue. I don't really get advance notice for who I'm going to see and sometimes people even have different last names, so I don't realize they're married to another patient of mine. Often the first I realize is when the patient says "since you know my husband X" or "my mom Y" but that's never been a probing statement. Nevertheless, I usually just say my blanket behavior is to never confirm or deny whether I see anyone else they name and never communicate any implied familiarity. I agree that if the relationship dynamics were more fraught, I'd look to transfer to another psychiatrist in the practice.

Found out yesterday I’m seeing the child of a former consult. I don’t predict it will be an issue as they were both straightforward and this person also seems very engaged and hopeful treatment will help, apparently they don’t know I saw their parent and I only plan to see the 1-2 more times, so hopefully shouldn’t be an issue.

 

[clausewitz2]

Found out yesterday I’m seeing the child of a former consult. I don’t predict it will be an issue as they were both straightforward and this person also seems very engaged and hopeful treatment will help, apparently they don’t know I saw their parent and I only plan to see the 1-2 more times, so hopefully shouldn’t be an issue.

I had a situation like this not too long ago. I would have had no idea if they didn't have the same distinctive last name and the son hadn't mentioned his mother's unusual medical history. I don't think he has the faintest notion I saw her. She is deceased now, which definitely makes things easier, and I plan to continue seeing him as a patient.

Without at all intending to, I have ended up in a situation where I am seeing multiple sets of adult siblings as patients simultaneously. Mostly the other siblings don't come up, so it hasn't been an issue. In one set of siblings the eldest did start to have a bunch of conflict with the others but thankfully that didn't start in earnest until he moved out of state and stopped being my patient.

 

[ObsequiousAplomb]

I have never done this on purpose, but it's happened to me at least two separate times.

1. two patients who independently become my patients over the course of a year. One of them said "I'm going to my girlfriend's parents' house for the first time" and a few visits later the other of the couple said "my boyfriend came to my parents' house for the first time. Oh, right, I should tell you..." I see them both for med management, but just the other day one of them was accusing the other of being agitated and verbally abusive, and the other was having less depression and less brain fog and more paranoia, so I switched his meds around. He had not been open with me about the psychotic symptoms in recent visits, so I'm very appreciative that his spouse said something to me. I hope it wasn't too big a rupture.
2. two patients independently become my patients within the same month. I treated them without knowing they were a couple for at least a year. One day the first one says "I broke up with my girlfriend, it was amicable and mutual." The other says "so my boyfriend just broke up with me, it was very sudden and one sided. You know him, he's [name]. I know I should have told you, but we actually started dating after we both became your patients!" They were nice enough, and he was moving abroad after that visit, so she continued in treatment.