What Is the Identified Patient?

Within the theoretical foundations of the ideas upon which much of what is called Family Therapy is based, is the key notion of the Identified Patient. Essentially, this is the person who has been somehow designated in the family as being the person with the problem. This person, not uncommonly a child, actually carries the symptoms for the entire family and is usually the individual first presented to a therapist as needing help.

Parents describe the problem as being the child and their attitude, mood or behavior. The hope and expectation on the first visit to a therapist tends to be that the mental health professional will “fix” the child and then everything will be OK. The expectation, even under the best of circumstances, is both unreasonable and not something likely to be achieved.

The problem is, of course, that this Identified Patient is, in reality, usually not the only person who needs help. More commonly, the entire family ‘system’ is out of tune and needs intervention that addresses the entirety of that system, not just the one person who is seen as being the problem.

Change is a lot easier to talk about than it is to achieve. In families, it is very difficult (often impossible) for any one member of that system to change unless the rest of the system can be readjusted concurrently. Another key concept in Family Systems Theory is that of homeostasis. Homeostasis can be best understood as the relational equivalent of the basic understandings in Physics of Newton’s Laws of Motion. Newton posits that “A body in motion tends to remain in motion” and that “A body at rest tends to stay at rest.”

In a family, there is a certain direction and momentum. Each member of that system plays some part in sustaining that familiar way of being. If/when one member tries to change, the natural reaction of the rest of that system (the other family members) is to try to restore things to the way they have become accustomed to them being. It is a bit like gravity pulling back toward Earth anything that tries to escape its pull.

Homeostasis means, literally, “standing still.” One piece of the system cannot change independently of the rest of the system. This is why most well-trained psychotherapists who work with children will not see them without the active involvement of the parents and/or the rest of the family in the treatment.

The Identified Patient is sometimes but rarely the only person needing help and although the family may recognize this and be willing to work on things together, the constant nemesis of homeostasis must be confronted and worked with if meaningful change is to occur.

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