Psyched Perspectives: Addressing Barriers to Collaboration Between Psychiatrists and Therapists

Delayed help-seeking and inconsistent coordination between disciplines limited the reach of relationship-focused therapy, according to Annika Marshall. Couples and families often presented in crisis, and Marshall noted that "people wait about 7 years after the problem has started before they reach out to a therapist."¹ Common presenting concerns included estrangement between adult family members, life transitions such as a new baby or a parent moving into the home, and caregiving strain in the sandwich generation. Marshall framed treatment goals around each patient's own balance rather than a prescribed outcome. Betrayal, including infidelity and financial deception, generally resolved along 1 of 3 paths: return to baseline, separation, or a transformed relationship.

Attitudes toward treatment further delayed engagement. Marshall reported that patients who sought therapy first often resisted medication, either because they equated it with failure or because they wanted to try therapy for at least 1 year beforehand. Frank Clark cited time, cost, and misperceptions about therapy as barriers among his patients.

Family-system and cultural context shaped assessment. Marshall used genograms, reflecting the Bowenian premise that a patient cannot be understood without understanding the 4 preceding generations. Both clinicians identified therapeutic alliance as central, and Marshall recommended interviewing 2 or 3 therapists before committing.

Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association's Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times.

Dr Marshall is a licensed marriage and family therapist and a visiting clinical professor of psychology in the online master of arts in clinical psychology program at Pepperdine University. She is the founder and owner of OC Relationships, a private therapy practice in California.

References

1. Doss BD, Rhoades GK, Stanley SM, et al. Marital therapy, retreats, and books: the who, what, when, and why of relationship help-seeking. J Marital Fam Ther. 2009;35(1):18-29.

2. Gitlin MJ, Miklowitz DJ. Split treatment: recommendations for optimal use in the care of psychiatric patients. Ann Clin Psychiatry. 2016;28(2):132-137.