Are Two Heads Better Than One?

Having trained in family systems I automatically usher out all who respond when I announce the new identified patient’s name in the waiting room. At the end of a new patient’s evaluation recently I asked whether I should know anything else before we talked about a treatment plan. The spouse nudged (as Phil Guerin might say) the patient, and I learned some critical information about the patient’s history that I might never have discovered without the spouse.

Classical approaches to psychiatry have emphasized the special relationship with the patient, boundaries, and absolute confidentiality. While this individual approach risks failure to obtain the kind of information a family member can provide, the patient might feel more comfortable revealing matters she wishes to keep secret from all but the psychiatrist.

Fortunately, we most of the time eventually learn what we need to know either way. But which way works best, and how do we know?

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