Ethical Issues in Split Treatment
There are many areas of potential ethical conflict when mental health professionals get into split-treatment relationships. These include state licensing laws, competency issues, psychiatrists being used as figureheads, delegation of medical judgment and financial arrangements (Lazarus, 2001).
The potential ethical pitfalls in split treatment arise from economic, manpower and clinical pressures. There is very lit-tle research, for example, into whether patients with severe bor-derline personality disorder should be in split treatment. These patients often do not tell the same story to each clinician (Main, 1957); they externalize their problems (Silk et al., 1995); threaten self-harm (Leibenluft et al., 1987); have emotional lability and substance abuse problems (Springer et al., 1995). If there is no close communication between the clinicians regarding goals, treatment planning, and role of medication and psychotherapy, the clinical and ethical problems in treating such patients are great.
It is important to recognize how complex and difficult split treatment can be for patients and clinicians. Key to this is recognizing the extra time and effort it will take to make obli-gations and responsibilities of all parties overt rather than cov-ert. Implied duties must be minimized. Some clinicians advo-cate the use of treatment contracts to cover the various issues and responsibilities that accrue in split-treatment arrangements (Appelbaum, 1991).