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Answer 2
  1. None of the above. Split treatment arrangements can be prone to pitfalls. Guidelines have been proposed2 to minimize these pitfalls and include avoiding poor communication between providers (as may occur by relying solely on the medical record); carefully choosing other providers to refer to (ie, those that share theoretical perspectives, especially regarding the usage of medication); and obtaining informed consent from the patient to share information regarding all facets of care between providers. The open sharing of information among providers will help to minimize the possibility that the patient will attempt to pit one provider against the other. In addition, this reduces the likelihood that providers will recommend conflicting strategies. Finally the guidelines stress the importance of clarifying the roles and responsibilities of each provider. One provider should not assume that the other is the “responsible party,” as this puts the patient’s welfare and safety in jeopardy. Some experts3 recommend legal contracts to further delineate the responsibilities. Although strict regulations exist to protect patient confidentiality, these should not be used as an excuse for failing to obtain informed consent for disclosure of treatment information between providers.

    1. Rand EH. Guidelines to maximize the process of collaborative treatment. In: Riba MB, Balon R, editors. Psychopharmacology and psychotherapy: a collaborative approach. Washington (DC): American Psychiatric Press; 1999.
    3 Appelbaum PS. General guidelines for psychiatrists who prescribe medication for patients treated by non-medical psychotherapists. Hosp Community Psychiatry 1991;42:281–2.

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