In health care, clinicians and patients commonly seek independent second opinions about diagnoses and treatment approaches. In psychotherapy, "second opinions" often arise through supervision. Supervisors' viewpoints may be distinctly colored by a school of thought under which the supervisor and therapist practice. Even those conversant in a variety of therapeutic methods risk missing the complete view of a challenging case unless skilled in integrating different perspectives.

Many training centers teach diverse psychotherapy techniques yet offer little formal instruction in how the techniques overlap, how and when to shift between different approaches in a single therapy, or how to incorporate the various approaches into an integrated model. The field is already eclectic; I see integration of the various approaches as its future.

With this in mind, colleagues at UCSF and I have established a new psychotherapy consultation service that takes an integrative approach. The Second Opinion on Psychotherapy Clinic at Langley Porter Psychiatric Institute-UCSF offers clinicians advice about ongoing psychotherapies. Consultation will usually involve obtaining information from the therapist and interviewing the patient, followed by a case conference with input from senior psychiatric residents and attending faculty. Occasionally, the psychotherapist may request a consultation for him or herself that does not involve interviewing the patient.

A written formulation and recommendation guidelines will be prepared for the therapist. The advice will draw from psychotherapy research literature as well as theoretical integrations of diverse schools. All practicing psychotherapists are welcome to make use of the service. For appointments or further information please call (415) 476-7510.

Mardi Horowitz, M.D.
Second Opinion on Psychotherapy Clinic at LPPI-UCSF