How Does a Consultant Therapist Work?

Reader’s Question

What is a consultant therapist and how does it work? Is it worth trying? I’ve been in therapy for some time — over two years with the current therapist. I have tried many different approaches he suggested over this time, from mindifulness and meditation to medication. Problem is my life has gone from a troubled but successful professional to someone who has trouble leaving the house. I’ve depleted my resources. I am not one for disability or a hand out. I am just looking for someone to help me make some practical moves in gaining my self esteem which both my therapist and I agree is key. Problem is it’s been 2 and 1/2 years and although I came to terms with my family issues I now can’t function in the real world. For the past year I’ve been trying to relay this to my therapist — partly I tried switching therapists but couldn’t find another one. It’s moot now due to my trust issues and anxiety and the fact that I have weeks not months before complete financial ruin finally occurs. My problem is I need a realistic approach to this, not a top of the trees conceptual discussion.

Anyhow for months now I have overcome my anxiety enough to raise these concerns with my therapist, but it’s not working. I know he’s a good person, but it’s like I’m trying to get back in the real world, not more entrenched in the therapy world (we already meet once and usually twice a week).

My therapist has suggested a consultant therapist; if I am able to get over my anxiety and open up to a third person what does this entail? Once again, he made the suggestion without explaining the process. When I inquired, all he really said was that it would take 2-3 sessions. Can you explain this? I have tried everything including hypnosis and trying something new isn’t the problem anymore. It’s getting my hopes up and the let down afterward.

So do consultant therapists work? What guidelines are there?

Psychologist’s Reply

A consultant therapist can be viewed in several ways, often like a “second opinion” in medical practice. The format is relatively easy — contacting another therapist, requesting a consultation, and presenting your case to them for their new and unbiased opinion and recommendations. When using a consultant, this is no time to be shy or hesitant or worry about trust issues — this is an opportunity so you must go for it completely. When your trusted family physician sends you to a specialist, you go with the understanding that you may need to “get naked” with this new physician — for the examination of course. In a therapist consultation, the same holds true. You must be prepared to be as honest as possible.

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You may also be experiencing a common situation in therapy. Most therapists are trained in certain treatment models. Some models and therapists are more philosophical and conceptual — “top of the trees” as you say. Others take a different approach. No one model fits all client situations. Your personal situation has changed over the last few years. When you’re fighting for your life in the forest, you may not need an assessment of the “top of the trees” — you need an axe! If your therapist is no longer understanding your position, you may need to consider moving on to another therapist and treatment approach. If the new consultant has the approach and attitude you need, you should be prepared to transfer your care.

I would additionally mention that some therapists are well-trained to identify psychiatric issues that would benefit from the use of psychiatric medications. In your situation, you are showing signs of a clinical depression that is slowly disabling you. If you’ve not already considered this, I would recommend consulting with your family physician regarding possible use of an antidepressant medication. You can read more about depression on this website as well as an article on my website at

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