You’ve made the decision: After years of contemplation and telling yourself you could handle everything on your own, you’ve finally decided you want to (and perhaps, need to) see a therapist. Now you need to actually find someone to see.
Frankly, you don't even know where to start. So you go to your usual sources, right? You start with a simple online search, and it is incredibly confusing. You then pull out your insurance card and call your insurance company. In between the hours of hold music and the long, disorganized list of names online, you give up.
Frustrated, you start venting to a friend/classmate/cousin/coworker, and they mention how much they love their therapist and feel completely understood by them. They even recommend that you see this therapist, too. Before jumping with joy at possibly being able to end this search process, you pause and wonder whether this idea requires more thought...
Even though therapists are bound by confidentiality ethics, is it really a good idea to see the same therapist as someone you know well?
In many cases and situations where access to care is limited—say, on a college campus or in a community with few resources—some people might not have much choice but to see the same provider as people they have a relationship with.
However, if you are in a position where other therapists are available and at your disposal (even if it’s an annoying or difficult process to land on someone), you might want to think carefully before immediately choosing to work with a therapist that someone close to you is already seeing.
Here are some things to think about when making that decision.
First, it could be weird for the person currently seeing that therapist.
Before you make the appointment, you may want to check in with your friend/colleague/ex/etc. again about whether they feel conflicted about you both working with the same therapist.
Let’s pretend we’re talking about a friend, in this example. While it’s unlikely that your friend was flat out lying to you when they suggested their therapist, the therapist-patient relationship is pretty sacred to people. It’s really not the same as merely introducing one person you like to another.
In the moment, when they suggested their mental health professional to you, your friend might not have been thinking too in-depth about this idea. But in actuality, it definitely requires more questioning and checking in with each other. I am not saying you need to ask 100 times for your friend’s blessing and assurance, but it’s probably worth asking them to really think about it—and to take time to do so.
You can explain to them that you know the relationship is important (and kindly acknowledge that they might even talk about you in session, and that’s OK!), so it is really up to them if they want or don’t want you to go to the same person. Then, emphasize that there will be no questions about why or any hard feelings if they decide to change their mind.
Some therapists actually have a rule against this.
Because of confidentiality laws, the therapist won’t acknowledge whether they also see this other person that you know. And, of course, the mental health professional is bound by law to keep information from sessions private and protected, so that makes it easier to maintain complete neutrality.
But know that it's not necessarily an easy task to master, and often the therapist will schedule friends on different days to keep some semblance of separation. It requires a lot of work on the therapist’s part to stay neutral and not let anything slip from the other person’s sessions (even a seemingly casual comment like, “I know,” “I heard,” or “I remember”).
Some therapists have their own rules against working with people within the same social circle or family. So if this therapist already has their own reasons for not seeing a friend of a patient, that potentially will make the decision easier for you both.
While it’s not considered unethical to see friends of friends, some therapists would prefer not to do that given the sanctity of each relationship. In some cases, a therapist will choose not to work with two people who are close with each other if they truly feel they cannot remain impartial. For instance, as therapists, we will not provide couples therapy to a couple when we already see one of the individuals as a patient one on one (it may come off as if the therapist is biased, even if they are not). Or, if we’re already seeing a couple, we typically wouldn’t then see the partners individually in counseling either.
Another extreme example: A therapist won’t see both a rape survivor and her rapist, or a person who was violently injured and the person who committed the crime. In those circumstances, the therapist might simply have to tell you that there is a conflict and they cannot be your provider.
Ethically, they won’t be able to say what that conflict is exactly, but they are obligated to provide you with referrals. This termination of the relationship may even happen multiple sessions in, as this information might not be discovered at the start. Keeping both patients in a sensitive situation (like with the example of two people involved in a sexual assault), however, would obviously not be productive or healthy for either party involved. The purpose is for both people to get better treatment, not worse.
Of course, in the case of a friendship, not every situation of going to the same provider is clear up front to the therapist (e.g. what if you just went to your friend’s therapist without even knowing it was your friend’s therapist and somehow discovered that over time?). I’ve seen situations where this realization comes out after a relationship with the therapist has already been developed individually for each friend. In those circumstances, it is less likely a provider will then abruptly end seeing one of you.
One avenue for deeper thought before you two make a decision, which you could suggest to your acquaintance, would be for them to talk to their therapist about this dilemma in session. There, they could work out the positives and negatives of the decision and get their true feelings out on the matter, as well as those of the therapist.
And, of course, consider if you might bring this person up in therapy.
Really, the most important question to ask yourself is: Are you going to talk about this particular person in therapy—possibly in a negative way?
Imagine being in a session and bad-mouthing your friend, or boss, or teammate. After listening to you, your therapist responds. Knowing that they work with your acquaintance, you begin to over-analyze any conversation, comment, or response they make about this person or your relationship.
For example, you may feel like a comment that just challenged your thinking was actually your therapist taking this other person’s side. Or, you may feel that they got fed the wrong information by, say, your best friend, and this is skewing their view of you. Because you know they see this other person (and can’t talk with you about it), it can feel like they are actually talking to you based on knowledge from the other persons’ sessions.
Although your therapist would of course deny this and, frankly, tries their absolute best not to do this and always stay completely neutral, the slightest hint of these feelings in a therapist-patient relationship can completely destroy trust. It can bleed into other conversations and other challenges or could make you shy away from ever discussing your friend, even if that is what truly needs to be talked about in session.
Ultimately, you want to feel that your work with a therapist is entirely unbiased, comfortable, and trusting.
If “sharing” a therapist with someone you know messes with that in any way, find someone else if you can.
Any good therapist will work to be completely impartial at all times. But even knowing this, it can be really hard to shake the feeling on your end that they may be unable to remain neutral when you know they are hearing information from multiple sources that are close to each other.
So, I would suggest assessing how close you really are with this person who recommended their therapist (if it’s someone you don’t really interact with all that often and it came up casually, it might be fine for you both!). And if you do have a tight relationship, talk to them about it candidly, and see if they would be willing to speak with the therapist about it too, before setting up your first appointment. And on the complete flip side, if you have a complicated or antagonistic relationship with that person, I would advise against it.
Trust, after all, is everything in therapy. Without it, it probably won’t be very successful.
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