bout thirty minutes into their hour-long therapeu- tic evaluation session, the adolescent girl leaped to her feet, screamed furiously at her dad and stormed out of the room, slam- ming the door behind her. There were a few seconds of silence, then the doctor spoke to the shaken, frustrated father, “I think I can really help you. Starting right now, let's you and me to work together.”
A
“Me?” the father asked in astonishment. “But I’m not the sick one.”
Ironically, that was precisely the reason the doctor wanted to focus on the dad and not the daughter. Traditional theories of psy-
chology are incredibly diverse in their concepts of the mind, and of treating emotional and behav- ior dysfunction. There is one com- mon thread, however, that runs through virtually every mode of therapy: the focus on the “identi- fied patient,” or as the harried father put it, “the sick one.” Even in the various types of family therapy, the primary goal is to eliminate disharmony and acting out behavior from the person in the family who is most troubled. What’s that saying: “The squeaky wheel gets the grease.” There is, however, one model of care-giving that focuses not on the most troubled person in the family, but rather upon the one who is emotionally strongest, the one most capable of change and growth. While the father of the angry adolescent might have felt overwhelmed and helpless at that instant, the doctor recog- nized the dad was the one who could respond best, and in doing so, bring wellness not only to his daughter, but the entire family. The doctor was using the model called Family Systems (also referred to as Emotional Process or Bowen Theory). From the Family Systems perspective, the “identified patient” is actually a sort of pressure valve for the anxiety and dysfunction that exists within a family. The idea is that, when the emotionally strongest person in the family—the leader of the family, whoever it might be—is empowered, healing spreads throughout the family. Thus
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the acting out behavior of the identified patient tends to atrophy and the family as a whole feels balanced. It’s enormously important to
state that many times the identi- fied patient or another family member may be in crisis when the need for help is first recognized. That is, if a person is suicidal, having a psychotic episode, over- dosing on drugs or engaged in other life-threatening behavior, it must be dealt with immediately. Once the crisis has passed, how- ever, the lasting change necessary for the wholeness of the family comes from shifting attention from the patient and onto the family leader.
What’s the Big Idea Exactly? Perhaps the easiest way to describe the fundamental insight of Family Systems is through what has been called “The Elevator Example”: if a group of strangers got into an elevator and the eleva-
tor became stuck between two floors for a couple hours, by the time the elevator began to move again, the strangers within would have formed themselves into a “family.” One or two people in the elevator would have taken on leadership roles; someone likely would have become annoying or frightened; someone else would begin to calm and console others. This is an “uncanny” process in that it automatically happens as a part of our shared human nature. We naturally fall into these roles in certain circumstances because human beings are emotional rather than rational beings. One current, joking quip making the rounds these days is, “I’ve already made up my mind. Don’t confuse me with the facts.” Only this is not simply a humorous jest; it is a fundamental real- ity of the way we live. In virtually every aspect of our daily lives, we make emotional decisions, then use our intellects to justify (to ourselves and others) the decisions we’ve made. Not only are we emotional beings, but we share “emotional
fields” with those around us. Another current quip these days is, “When Momma ain’t happy, ain’t nobody happy.” It’s observably
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