I encountered an issue during my clinical practicum where a patient's wife insisted on attending her husband's sessions. I found this a bit awkward and believed that it would have been counterproductive to have the patient's wife present during treatment (many of his issues related to his marriage). My question is, do you have a particular policy on allowing significant others in treatment sessions? I know that some therapists will almost always permit this if the patient requests it, and also many therapist's have a policy refusing to allow third party presence in individual session. Any thoughts?
Therapy - Third Party Present
- Thread starter BSWdavid
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Have you clarified with you supervisor who exactly is your patient in this situation? and whether you are doing individual or couples therapy here?
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Yeah, that is something that I would immediately go to my supervisor with.
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I personally would not allow it. I am not trained in couple's counseling and so I believe it would be out of my scope of practice.
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If I thought it would be contraindicated for the husband's treatment, then I would speak to both of them about it and share my concerns, otherwise I'd use it as an opportunity to work on their relationship.
It would be a much different scenario if you were doing an assessment and the wife wanted to stay. Having a 3rd party present during an assessment threatens the validity of the assessment. NAN released a nice summary of the issues here: http://www.nanonline.org/NAN/Files/PAIC/PDFs/NANPositionThirdParty.pdf
It would be a much different scenario if you were doing an assessment and the wife wanted to stay. Having a 3rd party present during an assessment threatens the validity of the assessment. NAN released a nice summary of the issues here: http://www.nanonline.org/NAN/Files/PAIC/PDFs/NANPositionThirdParty.pdf
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Have you asked your supervisor? Have you talked to your client about how he feels about this? Did he want the wife present? If he is there predominantly because of marital difficulties, MFT could be beneficial. Can your supervisor or another therapist on-site provide adequate supervision? Have you asked your supervisor? 🙄
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I would check with your supervisor and your client. Does your client want his wife there? If he doesn't want her there it could be extremely counterproductive. Also, if you aren't sure how to work with couples I wouldn't try it but suggest somewhere else for couples therapy unless you have some basic training in couples therapy.
Well, I think I covered all the bases suggested. I spoke to my supervisor who suggested against it, given the circumstances. I also shared my views with the couple. The patient initially stated he wanted his wife in the sessions, however, she was present when he stated this. Once we began working individually, he stated he was glad she wasn't there but didn't want to upset her. I also explained to the couple that if they were interested in marital therapy, I would refer them to a marriage therapist, but if the husband was interested in therapy for himself, the wife wouldn't be permitted to attend. In fact, the reason the husband decided to attend therapy was because the wife mandated it.
I guess I am curious whether or not it is ever appropriate to include a third party in individual sessions. I can imagine how it would be helpful occasionally, but is it appropriate to consistently have another individual present? Can therapy be successfully implemented with a third party's presence?
I guess I am curious whether or not it is ever appropriate to include a third party in individual sessions. I can imagine how it would be helpful occasionally, but is it appropriate to consistently have another individual present? Can therapy be successfully implemented with a third party's presence?
That is going to be HIGHLY context-dependent. In situations like this...where it sounds like one person is demanding to be there (quite likely due to their own issues) then I can't imagine it being appropriate...it is generally only going to impede progress and cause problems.
If we are talking kids...its not at all unusual for parents to be present. Even with adults it can sometimes be helpful to obtain corroborating reports, discuss ways the 3rd party can work with the client to help them with a certain issue, help with exposures/role-plays, etc. etc. etc. Heck, some therapies are centered on the idea of having multiple people present (e.g. family-based therapies), so it depends what you are doing.
I've never had to do it, but I believe bringing in a 3rd party should be a collaborative decision between you and the client you are treating. The third party is not your client, and should not be involved unless you AND your client think it would be helpful. If either one or both is not okay with it, you are just asking for trouble.
If we are talking kids...its not at all unusual for parents to be present. Even with adults it can sometimes be helpful to obtain corroborating reports, discuss ways the 3rd party can work with the client to help them with a certain issue, help with exposures/role-plays, etc. etc. etc. Heck, some therapies are centered on the idea of having multiple people present (e.g. family-based therapies), so it depends what you are doing.
I've never had to do it, but I believe bringing in a 3rd party should be a collaborative decision between you and the client you are treating. The third party is not your client, and should not be involved unless you AND your client think it would be helpful. If either one or both is not okay with it, you are just asking for trouble.
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This is consistent with what I've done previously. If a patient requested a third party (spouse, parent of adult patient) to join us for a session, we would discuss the rationale behind the request, what the goal would be for that session, and what my role would be in the session (provide education to the family member? be present for moral support? mediate?). If we agreed on a plan, the patient would invite the third party to a future session. It might take several sessions to get there, as sometimes my patient needed to practice some role-playing exercises or explore and understand their relationship dynamic better before this type of joint session would be beneficial.
On rare occasion, a patient showed up for an appointment with a third-party in tow without my prior knowledge. In those cases, I made it my policy to meet individually with my patient to go through the above discussions. If the request was for something like education of illness, I might bring the third party in for the last half of the session. Otherwise we'd go through the steps above to prepare for a future joint session.
