Know the Options: Three Roles of Other

In my ( John’s) experience it has almost always been easier to switch from working with couple and family systems to working with indi- vidual subsystems. The reverse however, has often been more difficult as a client seeing me one-on-one may develop a sense of ownership (e.g., you are my therapist), which to the client can feel like a loss when an other is brought into session. Some clients may outright refuse to consider allowing an other into therapy, citing concerns about how s/ he may be treated by the other (either in therapy or at home following the session). Conversely, some clients may want an other to be part of therapy, but believe this other will be unwilling to or uncomfortable participating. In response to these valid concerns, when discussing with a client the possibility of an other coming into session consider the following roles and their functions, which we offer here in rank order from least to most ideal:

Role 1: Observer.

An other may be invited into session as an observer who is expected only to watch. With the observer present in session a client is free to choose what to discuss. For therapists having the observer present can bring about changes in a client’s verbal and non-verbal presentation, which can reveal systemic and contextual aspects of a client’s presenting concerns. This role may also allow an other to experience the content and process of therapy without having to self-disclose, which may facilitate him/her becoming a full participant in future sessions. When working with couples an observing other may develop a deeper appreciation (i.e., empathy) for the client’s intra-psychic dynamics, which may also prompt him/her to become a full participant in future sessions.

The collateral contact role is for an other who may be uncomfortable with the idea of therapy. To ameliorate this discomfort the other may join the session with the understanding that for diagnostic purposes s/he is simply providing data on the client. In this role the other is free to discuss his/her own issues. However, it is agreed ahead of time that the focus of the session is the collection of data about the client and his/her presenting concerns. As in the observer role the collateral contact role may reveal intra-psychic and interpersonal dynamics gleaned through changes in a client’s verbal/ non-verbal presentation. The addition however, of the other’s perspective on the client’s presenting concerns can more readily uncover systemic and contextual aspects vis-à-vis what the other says about the client (i.e., content) and how they say it (i.e., process). This can also provide the therapist an opportunity to discuss the systemic nature of the presenting concern, thereby converting the other to a full participant in future sessions (of course, doing this in a non-threatening manner is yet another skill to practice).

We offer herein that the full participant role may be the ideal role for an other to take in therapy. In this role an other agrees to become a client (i.e., the system becomes the client). This role most readily and directly allows therapists to address systemic and contextual aspects of the client’s original presenting concerns and will likely involve the therapist and client-other system deciding that treatment goals should be rewritten to include an other’s presenting concerns.

In the current mental health paradigm MFTs and interns alike are inundated with assessments, diagnoses, and interventions that frame clients as decontextualized beings suffering from linear and inter- nally-based disorders. To counter these influences interns and their supervisors must work together, intentionally conceptualizing the systemic and contextual aspects of a client’s presenting concerns. But conceptualization alone is insufficient: It is also necessary to learn how to challenge while simultaneously validating clients’ trepidation about bringing others into therapy—what Minuchin might frame as a “hug and a kick.” By practicing these skills during internship, supervisors can help ensure that future MFTs will have the ability to simultaneously validate and challenge the suprasystems that continue to privilege a linear and decontextualized paradigm of mental health symptomatology.