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My wife, Donna, and my 4-year old son, Joshua, were recently walking on a path along an embankment near the ocean. I was walking behind, with Donna and Josh in front holding hands. As they reached the narrow part of the path, she said to him, “You walk on the inside here.” When he asked why, she said, “It's slippery here, and if someone has to fall, I'd rather it be me.” Josh paused for a moment to consider this, then looked at her, and said, “I'd rather it be Daddy!”
The internalized influence of ‘the third party’ always has an impact on any dyadic relationship. In the family, the father's role impinges on the mother-child dyad. The early symbiosis of mother and child allows the child to develop a sense of trust and provides the safe context for the emergence of the self and the capacity for relatedness. The father's role as the initial ‘third,’ though typically experienced by the child as an unwelcome intrusion, is central to the ultimate development of autonomy and reality testing. Throughout family life, any pair is inevitably related to the larger family context as the ‘third’ to the dyad, containing and representing family standards and the family's developmental task (Shapiro and Carr, 1991; Muller, 1999). The internalization of the notion of ‘family,’ defined by its task, is central to the possibility of family interactions being embedded in a shared reality.
The doctor-patient dyad and the context of treatment have similar dynamics. The clinical task that doctor and patient negotiate provides the central context for their relationship. Like the family's developmental task, the clinical task is the stabilizing force that gives the doctor-patient relationship a reason to exist and protects against delusional pairing. Increasingly, however, the treatment task is