Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Collaboration between prescribing physicians and psychotherapists in mental health care

Andrew Skodol, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Patients treated with medication and psychotherapy for a mental disorder may be treated by a single clinician, typically a psychiatrist, or by two clinicians, one prescribing medication and the other providing psychotherapy. Provision of the two modalities by two clinicians is often referred to as “split” treatment, while provision by one clinician is described as “integrated” care.

The prevalence of split mental health care appears to have risen in recent decades. Potential hazards of split treatment can occur when psychotherapy and pharmacotherapy are not well coordinated. They can be avoided if the prescribing physician and the psychotherapist proactively communicate with one another and establish procedures to support an effective collaboration. There are no data from clinical trials comparing the quality or outcomes of care between split versus integrated treatment.

Provision of a patient’s care by two or more clinicians is not unique to mental health care. Care is typically split between primary care and other medical specialists, as well as between physicians and non-medical clinicians such as physical therapists. This topic emphasizes issues encountered in providing mental health care.

This topic describes challenges associated with split treatment, and describes approaches to collaboration under this model of care. Other features of the clinician-patient relationship in mental health care are discussed separately. (See "Establishing and maintaining a therapeutic relationship in psychiatric practice" and "A patient-centered view of the clinician-patient relationship".)


Split mental health care occurs when a patient receives two or more modalities of treatment from two or more clinicians. Split treatment is most commonly delivered by a:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Pincus HA, Zarin DA, Tanielian TL, et al. Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network. Arch Gen Psychiatry 1999; 56:441.
  2. Olfson M, Marcus SC, Pincus HA. Trends in office-based psychiatric practice. Am J Psychiatry 1999; 156:451.
  3. West JC, Perry JC, Plakun E, et al. Psychotherapy practices of psychiatrists in the US: Patterns, trends, and barriers to psychotherapy. Presented at the Annual Meeting of the American Psychiatric Association, Philadelphia, Pennsylvania, May, 2012, and at the Institute on Psychiatric Services, New York, New York, October, 2012.
  4. Kalman TP, Kalman VN, Granet R. Do psychopharmacologists speak to psychotherapists? A survey of practicing clinicians. Psychodyn Psychiatry 2012; 40:275.
  5. Mikkelsen EN, Petersen A, Kaae AM, Petersen H. Cross-sector problems of collaboration in psychiatry. Dan Med J 2013; 60:A4707.
  6. Cruz M, Roter D, Cruz RF, et al. Psychiatrist-patient verbal and nonverbal communications during split-treatment appointments. Psychiatr Serv 2011; 62:1361.
  7. Avena JA, Kalman TP. Provider communication in split treatment: a survey. Psychiatr Serv 2010; 61:729.
  8. Lorenz AD, Mauksch LB, Gawinski BA. Models of collaboration. Prim Care 1999; 26:401.
  9. Goldman W, McCulloch J, Cuffel B, et al. Outpatient utilization patterns of integrated and split psychotherapy and pharmacotherapy for depression. Psychiatr Serv 1998; 49:477.
  10. Gutheil TG, Simon RI. Abandonment of patients in split treatment. Harv Rev Psychiatry 2003; 11:175.
  11. Lazarus JA. Ethics in split treatment. Psychiatr Ann 2001; 31:611.
  12. Mark J. The challenges of split treatment. Psychiatr Serv 2001; 52:1254.
  13. Dewan M. Are psychiatrists cost-effective? An analysis of integrated versus split treatment. Am J Psychiatry 1999; 156:324.
  14. Baruch RL, Vishnevsky B, Kalman T. Split-care patients and their caregivers: how collaborative is collaborative care? J Nerv Ment Dis 2015; 203:412.
  15. Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525.
  16. Bradley SS. Nonphysician psychotherapist-physician pharmacotherapist: a new model for concurrent treatment. Psychiatr Clin North Am 1990; 13:307.
  17. MAIN TF. The ailment. Br J Med Psychol 1957; 30:129.
  18. Gabbard GO. Splitting in hospital treatment. Am J Psychiatry 1989; 146:444.
  19. Gabbard GO, Wilkinson SM. Management of Countertransference with Borderline Patients, American Psychiatric Press, Washington DC 1994.
  20. Deen TL, Fortney JC, Pyne JM. Relationship between satisfaction, patient-centered care, adherence and outcomes among patients in a collaborative care trial for depression. Adm Policy Ment Health 2011; 38:345.
  21. Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010; 363:2611.
  22. Gilbody S, Bower P, Fletcher J, et al. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006; 166:2314.
  23. Fortney JC, Pyne JM, Edlund MJ, et al. A randomized trial of telemedicine-based collaborative care for depression. J Gen Intern Med 2007; 22:1086.
  24. Beitman BD, Chiles J, Carlin A. The pharmacotherapy-psychotherapy triangle: psychiatrist, nonmedical psychotherapist, and patient. J Clin Psychiatry 1984; 45:458.
  25. Schlesinger AB. Collaborative treatment. In: The American Psychiatric Publishing Textbook of Personality Disorders, Oldham JM, Skodol AS, Bender DS (Eds), American Psychiatric Publishing, Inc, Washington DC 2014. p.345.
  26. Waldinger RJ, Frank AF. Clinicians' experiences in combining medication and psychotherapy in the treatment of borderline patients. Hosp Community Psychiatry 1989; 40:712.
  27. Paris J. The Use and Misuse of Psychiatric Drugs: An Evidence-Based Critique, J. Wiley & Sons, West Sussex, UK 2010.