Transferring To A New Therapist

In this transcribed episode of the Shrink Think Podcast, Nathan and Aaron talk about transferring to a new therapist—what you need to know and steps you can take to prepare for a smooth transition. 

Aaron Potratz:

Hey, everyone. Welcome to the Shrink Think Podcast. We are here on this lovely snowing day, and we are recording here in Oregon in March, actually.

Nathan Hawkins:

This is not Alaska, by the way.

Aaron Potratz:

No. You might be deceived if you were to see it outside. But we are excited to be here and talk about a very helpful topic. Actually, I've mentioned it to a couple of people in the past week or so since the idea came up, and I think it's going to be really helpful. Everyone that I've talked to has said that it's one of those subjects that's really kind of overlooked, I think. Everybody sort of just deals with it, which is actually a lot of what our topics are. People just deal with it, and we're like, "Why? Why do you have to deal with it? Let's talk about it on our podcast. Let's expose that thing."

So we're going to be talking about transferring to a new therapist. So I guess it's for clients who are going to therapy, and maybe for whatever reason, good or bad, maybe it's a normal thing. I've got a friend who is closing her practice, taking another job. Shout out to Heather, what up? She is closing her practice, and so her clients need somewhere else to go to a new therapist. There's nothing bad that's happened in the relationship; they just need to continue whatever they're doing with someone else. And maybe there's another situation out there, where they've gotten what they need from their current therapist, and they need something else or something different. We've talked about that on our podcast before. That's a thing.

So what do you do? How do you make that handoff well? And what do you need to know transferring to a new therapist? What can you do with your current therapist to prepare yourself for this transition? And then, of course, on the other side, you've got if you are a therapist, what are some things that you need to know? Because, and I'm just going to let you guys know, I feel like a lot of therapists don't really know or they don't really think about this a whole lot, they just focus on basically closing out their current client and making sure that they end that relationship well. Probably a little bit of a transition, make sure that they've got some referrals to this new person, but maybe it's not as much handoff or as much connection, smooth transition between those two things as possible. So, we're going to unpack that a bit. And to be honest, we have not scripted this. We haven't really even talked about it. But these are the things that we do on a daily basis, so we're like, "Let's just open a bag and see what we packed."

Nathan Hawkins:

What do you mean we don't script it? We don't write out every single conversation ahead of time.

Aaron Potratz:

Yeah. We haven't made an outline.

Nathan Hawkins:

"This is what you say now."

Aaron Potratz:

Yeah. Right? Nathan, you laughed too early. You had to wait a little bit. Okay, now you can laugh.

Nathan Hawkins:

That was honestly accidentally perfect. Anyway, I think the thing you brought up there at the end, I think, just to be clear, and I'm sure you agree with this, that referrals are normal, right? There is a difference, though, between making the decision as a therapist of when it's just whatever the thing is, is not your thing. So, getting in, for example, with the easiest one, I think, the easiest one to see, is working with couples when you're a therapist. Because it oftentimes can get to the point with a couple that you realize, "Okay, there's some other mental health stuff going on here." And then, part of that decision is can you do a one-off? Can you...

Aaron Potratz:

Meet with one person individually.

Nathan Hawkins:

Yeah, maybe one or two times and just fix it, so to speak, express it, to picture... Probably expressing as if that's an evil thing you don't think about it, but just and move back in, move back into the couples. But there are some times when you realize, as a therapist, "Okay, this is not going to work. There's too much going on." So you end up essentially getting out of the couple dynamic entirely. And so, that process, which we can talk more about, I'm not sure which direction you want to go first, and with the individual person that's in there.

Aaron Potratz:

The client.

Nathan Hawkins:

The individual client, that one's a little bit more... I think it's honestly a bit more difficult for the therapist, because to kind of realize the difference between referring for a specific situation and referring because you... Especially for younger therapists, there can be this element of, "Oh, I'm not very good at this. Maybe somebody else should do it." Because there's already, we've talked about it before, imposter syndrome and that thing.

Aaron Potratz:

Or maybe somebody just, as you've been working with your client, you've discovered that maybe it's more complex than you realized, or there are just more issues going on that you are not... This isn't your specialty, and somebody else that's got more expertise or experience might be better suited to work with them.

Nathan Hawkins:

And honestly, the hairy one, the one that's just hard to deal with if you're in that situation, the complexity, is the personality disorders. You get into that and you realize, "Oh my goodness, I do not work with this. I don't even kind of work with this." And with personality disorders, it's often true that it's unlikely, statistically, that things are going to "get fixed." And then, on the other side, it's hard to tell somebody, that conversation like, "Oh, we can't work together because you're a narcissist. No, you actually have a personality disorder, not kind of. You're not just self-absorbed. You have a personality disorder."

Aaron Potratz:

So I'm glad you said this, because this is kind of getting into how do you prepare those people for moving to the next person? Again, whether it's you're going to smoothly transition and continue your work, or in this case we're talking about, "You've got some issues and some needs that I can't provide services for. I'm not the right fit for you." So in that case, you would be well suited I think, to call out whatever those things are, put some labels on those things. And I don't mean you're just labeling stuff like, "You've got this disorder, you've got that disorder, you've got this other disorder, and these other disorders as well."

Nathan Hawkins:

"You are so messed up. You need a specialist, which just probably doesn't even exist."

Aaron Potratz:

Right.

Nathan Hawkins:

Good luck, Google.

Aaron Potratz:

That's not what I mean. It's more like, put a word to whatever it is that you've been diagnosing and treating so that the other person, the client, knows exactly what it is that we've been working on. Sometimes you don't have that conversation. Maybe you do in the very beginning, and then you just kind of continue on with your treatment, and maybe you don't really know the specific nature of it.

But when you need to package it up and then bring it to a new therapist and then basically give them a summary report, so to speak, of what you've been working on in your previous therapist's office, then you need to have some words and language around, "Okay. This is what my diagnosis was" or "These are the issues I've been working on. This is a rough outline of my treatment plan, and this is where I'm at in my progress." That kind of stuff, as a therapist, is great to be able to give to your client so that they know, and they can kind of write down or if you want to write a summary statement or whatever. Develop something together so that you're on the same page about, "Here's what we've been doing, here's where you're at in it, and here's what you need from this next therapist so that you can pick up where you left off in my office."

Nathan Hawkins:

So, let's do a common one. Maybe each one of us give an idea of how we would handle it. The common one on the therapist side, I feel like, is bipolar and borderline. So on paper, so to speak, on the intake process coming in, it's not necessarily that easy to discern. Obviously, you have to meet the person to understand what's going on. And on paper, the irregularity of somebody's actions and what they're reporting could be related to mood, not necessarily the psychology of personality. So you can think that this person might have bipolar, and then as you get to know them better, you realize it's not about mood dysregulation, it's more like, "Okay, this is a personality dysregulation." But you can be pretty far down the road sometimes. And I've had to deal with this question. And typically, the way it ends unfortunately, is the borderline person keeps kind of ramping up in the behavior and the therapist realizes that they're borderline when it's kind of beyond where it should have been.

Aaron Potratz:

Like now that it's too late, it's like, "Oh, now that it's hit me in the face, like a 2x4, oh, it's a 2x4."

Nathan Hawkins:

Right, right. "I hate wood." Right? Anyway, stop it. I was thinking in relationship to this, probably what I would do, it's been a long time since I've actually had to deal with that and that's probably just fortunate. It has nothing to do with screening in that way, because this is a sneak past the goalie one. I would speak more in general terms.

In therapy, one of the things we do at diagnostics is we have these things called rule-outs. And what those are is kind of just speculation, right? So I'm talking to the client right now, and I'm saying, "Where we have been conceptualizing you as we've been working is with bipolar. You've talked about that, we've talked about that. And what I'm recognizing now is that we probably need to work towards ruling out what's called borderline personality disorder. And the problem with that for me, as a therapist, not for you, is that that's not really in my specialty. I'm not sure how well I can discern that. So what I need to do at this point is we need to work to referring you to someone who works with this on a more regular basis. And so, what questions do you have of me?" Because then, I'm trying to keep this global. We're not making the person a problem. We're inviting them into this whole process, basically helping them to be a part of the switch, the change of what's going on in therapy.

The other piece, too, that you end up having to navigate when you put those questions over in my mind is the relationship. "Well, did I do something wrong?" Those kind of questions that the person might ask. "What do you mean? What's the problem?" And unfortunately, some of these disorders come with it that the person could dysregulate, and they could be completely mad at you as a therapist for even saying this, like, "I can't believe" and "You're just like everyone else" and that kind of thing. And so, because of that, you would want to bring this in probably in the first 20 minutes of the session so you have plenty of time to be able to navigate this.

And also, before you bring it up, reversing. As you look at your caseload, you need to have reached out in the sense of at least searched for kind of who out there in your community probably is more likely to be able to work with the situation. So that's kind of your due diligence. I'm not sure if you would add or change anything.

Aaron Potratz:

No, no. I want to move into what do you actually say to the client so that they can package this up and take this to their therapist? Because I think a lot of people, what I'm hearing is they'll go to a new therapist and the therapist will say, "Okay. So you've worked with this other person. Where are you at? Who are you?" Or the person is like, "I don't want to start over. I don't want to tell my whole story."

And actually, this was really good. A couple of people that I talked with, their therapist told them, "Don't start over. Don't tell them you need to start over. We've already gone over that. You don't need to tell your entire story. Maybe you can give them these highlights. You can tell the therapist, 'These are the things that are impactful, like my dad was an alcoholic and then my mom took us in the middle of the night and we ran away when I was 11 or whatever. And that has resulted in these kind of symptoms or these dynamics with me. Maybe it's affecting me in these ways or I have these kinds of relationships because of that, and I'm working on codependency or expressing my needs or whatever.'"

It's like great. That's a good story, a summary of your issues, without going into, "So, tell me your name and what was your relationship with each one of your parents?" And you're like, "Ah, we've already been over this." Right? It's like you can summarize all that stuff and you can give this to your clients so that they're prepared to say and to know when they go into that therapist's office, "I don't want to waste my time. I just want to pick up where I left off." And that therapist can hopefully, if you're listening to this, you can take that and say, "Oh, okay. I'm going to skip over some of this background stuff because this other therapist prepared you well. They also listened to the Shrink Think Podcast, and so we're on the same page."

Nathan Hawkins:

That's obvious. So the other thing though, in light of that that you can trust, as a client, so if you're listening to this thinking, "Yeah, but there's a lot of detail there. There was a lot of work there." Naturally, us as therapists, when you give us that summary, we may say something like, several sessions down the road, you've transferred, you're over, "Hey. You mentioned before that your dad was an alcoholic. Can you tell me more about that?" Because if it's something that's coming up and the therapist needs to know, they will ask. Because it'll be one of those things in our minds as we're just thinking about how to help you, it comes up of, "Oh, they did this, but..." The same way, actually, we might remember an intake in a situation of where we haven't done any work and we've just wanted to ask that question. It's we realize, "Oh, this could apply." So we'll ask more about it. You don't have to worry that, "Oh, no. Well, it's not going to be enough. It's never going to be the way I need it to be." It will be.

Aaron Potratz:

So maybe one of the first things that you can do with your therapist is start by asking and answering the questions, "Okay. Client, what is it that you want or you need your next therapist to know about you?" And then, maybe you can ask that same thing of the therapist, "What does the therapist think that this new therapist needs to know from professional to professional?" Right?

So you each have your own lists of things that you need to say, and then you can talk those through. How do we package that well so that you as a client, if you're listening, you can say those things concisely in a way that's going to make sense to the therapist's ear? So you can have that conversation and talk with the therapist about it, maybe kind of revise it a little bit or edit it down so that it's sort of consumable. It's true to you as a client and your story, but it's also consumable for the therapist to hear in a way that's going to make sense to them and be useful to you. But then also, what are some of the things that the therapist can say to the new therapist of like, "Hey, you need to be aware of this. When this thing happens, this person is going to need this kind of care. That's what they respond well to," for example.

Nathan Hawkins:

Right. One of the things that I would love to hear as the therapist that's receiving you, after you've done whatever work, would be, I want to have an answer to the question, "What was the most crucial part of your change process that really made sense to you?" Because that tells me how you process. It tells me what it is that was important to you as far as what was on your mind. And it also means that now I kind of have more of a direction in my mind of what you're passionate about, what you hope to have with me, and where you're hoping to go. Because I can ask questions like, "How was that important to you? How are you expecting that exact same thing now as we move forward? Maybe you're in a different space, maybe you necessarily won't, but how do you imagine that would happen?"

Aaron Potratz:

Or even, "What made that possible?"

Nathan Hawkins:

Right, right.

Aaron Potratz:

"If that was the thing, what did you guys do together to make that possible that led up to it?" Or even as you're saying that, I'm thinking, "What are some of the dynamics between you and the therapist that made that possible? Or what were some of the dynamics between you and the therapist that were really valuable and impactful to you that maybe I need to pick up and pay attention to between us?" And it doesn't mean that I need to be that other therapist at all. That's not what we're saying. It's more of like, "Well, I would say this and then my therapist would always stay on me. Instead of letting me kind of meander into whatever, the therapist would stay on me and challenge me like, 'I see that you're kind of wandering a little bit. Can you stay focused on this feeling?' And that was really helpful because I didn't want to go there, but I knew I needed to." And so, that's the kind of dynamic that maybe you're needing from your new therapist. Anybody can do that if they know that that's the relationship dynamic.

Nathan Hawkins:

Right. The other piece of that that just needs to be honored is sometimes you just have a click with the other therapist. There's just a personality click. And you recognize that was a huge part of the transformation you've already gone through. That's okay. And it helps the therapist that you're sitting with know, "Okay. Well, probably the relationship is going to be a big deal. You take this relationship seriously. And whatever happens next is going to be different, so that part is important."

Aaron Potratz:

And that's okay. It's really interesting, because I can think of somebody... Nathan and I are similar in certain ways, but we are also very different in a lot of ways, very different I think in our styles. And I can think of someone that has worked with me and then is working with you.

Nathan Hawkins:

Oh, yeah.

Aaron Potratz:

And I know that she gets a lot out of her therapy with you, and I'm pretty sure she got a lot of out of her therapy with me. I'm hoping that was the case, that she didn't leave from me to you because it's like, "Well, that's enough of that." I think I'm a good therapist, so I think I did what I needed to do for that time period. And even though she went to you and you are a totally different person, different style, different personality, she can still benefit. And she has still been benefiting for the time that she's been working with you. Even though it's different, people will bring out different sides of you or they'll impact you different. And just because it's different doesn't mean it's not going to be effective.

Nathan Hawkins:

Yeah. I thought you were going to go a different direction, because the other person I have in mind interviewed both of us, went to a couple sessions, and that person is still with you.

Aaron Potratz:

Right. She was like, "Nathan, not going to do that one. Nope. No, thank you."

Nathan Hawkins:

What was interesting to me about that though, was normally you actually don't hear anything. So there's some people out there, some clients, that will go to different people and then they... They're just gone. You check in to see, "Hey, did you want to get on the schedule?" They just don't write you back. They ghost you. In this situation, it was like, I get to find out exactly what. I know. And it was honestly just a focus and a personality difference.

Aaron Potratz:

That's right.

Nathan Hawkins:

It had nothing else to do with anything. And I was like, "Oh, yeah. Well, we are different." And that is the way that we are different. So it just was very specific, and it was interesting.

Aaron Potratz:

So, if you're the new therapist and you are receiving this client, I think it's really important for you to know that this person has done some work with their therapist and hopefully that therapist has prepared them well to transition to you. I do get people like, "Oh, yeah. My therapist is retiring. I need a new person to work with. Can this be you?" When I'm receiving a new client in that situation, I'm making some assumptions that they've done some good work with that previous therapist. They have some awareness of their issues, they can communicate those to me. And so, I don't necessarily need to start from the beginning.

So, I guess that's partly what I'm saying is, if you're a therapist that's receiving a new client, don't think that you need to start from ground zero, from, "Let's go back all..." Because that's what you do with every new person is you're like, "Okay. Let me get your whole history, your whole story. Let me run through all of it."

"No, no, no, no. I'm continuing where I was at." So I need to be able to skip over all that. And in fact, it's going to be a huge waste of my time, a turnoff. It's going to be a relationship stress if I have to sit through all of this as a client, because I already know all this. So, if you're a therapist receiving that person, let yourself skip past that and try to pick up where they left off as best you can.

Nathan Hawkins:

Yeah. And remember, remind yourself it's okay. A lot of times, the main thing that happens, the main transition that happens, is the person didn't have a good fit with the therapist where they're coming from. And so, that part of it oftentimes is therapists will think about all the stuff we have to fix or repair from the other situation like we're somehow a better therapist or whatever. "Of course, you found me. I'm awesome."

Aaron Potratz:

And then, the next person is going to have to repair with you.

Nathan Hawkins:

Exactly. Yeah.

Aaron Potratz:

That's what Nathan's been doing with this lady.

Nathan Hawkins:

Oh, yeah.

Aaron Potratz:

She's like, "I spent two years working with Aaron and I'm really traumatized." And he is like, "I know, I know. We're working it out."

Nathan Hawkins:

"It's okay."

Aaron Potratz:

"It's going to take a while to recover."

Nathan Hawkins:

"It's going to be fine." Yeah. So I just wanted to honor that. So, in conclusion, what you want to do is get prepared in the sense of knowing what it is that you're going to say in the next situation. So if your therapist, for example, wasn't thinking about that upfront, maybe it's kind of more of a thing that you are realizing needs to happen and you've brought it up, just let them know, "I would love to process what it's like to transition and develop an actual plan of something to give the next therapist." The therapist you're talking with that you're transitioning from should kind of intuitively know what it is that you need to bring with you, and they should not be offended. And I don't like to shit on people, but that shouldn't happen.

Aaron Potratz:

Actually, when I get those kinds of things, it feels like the client is super prepared. They're very prepared to do this work, like, "I'm here and I want to do these things. Can you help me?" And I'm like, "Whoa, this is awesome. You're ready to go. You must have listened to the Shrink Think Podcast."

Nathan Hawkins:

Right. Oh, my goodness. Yeah. And just keep in mind as a therapist that this is all, as you already know, kind of a normal part. But for the younger folks out there, as therapists, there's a difference between referral and transition and just looking every time that you think that you do need to refer, "Do they need to transition? How significant is it? And how am I going to prepare to do that?" Because it is different. And so, if you can, be honest with yourself, both therapist and client. Be able to receive the information and just know that this is just about health. This is not about any one person. It's about the goals of the client coming to fruition in the best and fastest way possible, in the less stigmatizingly way possible. So with that, have a great day.

Aaron Potratz:

Thanks for listening to our show. Don't forget to head over to Apple Podcasts, Spotify, Stitcher, or wherever you get your podcasts to leave us a review and subscribe to our podcast so you never miss an episode. You can also visit our podcast page to sign up for our free email course, Nine Ways to Overcome Fear and Self-Doubt. And you'll get nine weeks worth of customized, practical strategies you can use to get past the fear that's holding you back in your life. Thanks again for listening.