This week I attended a course on family systems and the thing that stood out most was the ‘identified patient’ within families. So often one member of the family is seen as ill and acts as the scapegoat for the family’s problems, when in fact it is a family, systemic problem and all members are playing a role in the maintenance of this. In fact, the ‘patient’s’ expressions of illness or madness are often adaptive attempts to survive in an intolerable situation and upon exploration make complete sense. Each family has its own ‘official story’ and this includes each individual members’ roles, where and with whom the problem lies and with this comes certain expectations and assumptions. What is your family’s story? What are your implicit family rules and values? For example, how might you answer:
We are the family that always….
We are the family that values…. and never is one that….
Families resist change and try to keep the homeostasis, so inevitably if you start to change, the system is required to change and the functionality of the family will be reflected in its ability to adapt to the changing needs of individual members.
Here are some questions that I found useful to consider:
What does family mean to you? What strengths have you gained from it, as well as how has it hindered the way you relate and see yourself, others and the world? Who is included in your family – are friends, cousins, or just immediate family? How do members in your family tend to communicate? How is conflict managed? Who makes the decisions and when? Where are the coalitions and who feels responsible for whom? As a child how were you responded to when you cried or expressed a feeling and what did you need? How has this informed the way that you manage feelings and express feelings today? How has your sibling position effected who you are today? We tend to operate in triangles where there are always two insiders and one outsider, but the switch between these dynamics can happen quickly. Where do the triangles exist within your family and what is it like to be in such triangles? What are the benefits and costs to your family role and how could you change your position?
We so often reenact our family roles in new groups and relationships. Where do you tend to respond in your family role? How is your identity informed by and differentiated to your family’s?
Where is home for you? Is it one place or multiple? Is it a physical place or an inner sense of home that you take with you? Where and who with do you feel a sense of belonging, if at all?
If you would like to explore some questions like these or do a Genogram of your family in a session just let me know.
The idea that the scapegoat, or identified patient, holds the family’s pain, when in fact each member of the family is hurting in their own individual way and it is pain and problems that has so often been passed down across generations, makes it so important to decentre the problem from one individual. The idea of reframing difficulties and understanding the personal meaning of symptoms and madness, though unrelated to families and family therapy, reminded me of a brilliant Ted Talk by Eleanor Longden on hearing voices:
Some interesting pioneers who researched into families and conducted family therapy: