The child who carries the family’s pain: Rethinking the Identified Patient
For decades, therapists and families alike often saw the “problem child” as the source of distress. Behaviour, whether disruptive, withdrawn, or symptomatic, was located within the individual. Yet family systems theory has long offered another perspective: what if the child’s struggles are not the problem, but a symptom of deeper tensions in the family system. This child has been called the Identified Patient (IP), the one who carries the family’s unspoken pain.
The concept of the Identified Patient (IP) was first introduced by Dr. Murray Bowen in the context of family systems theory in the 1950s–1970s. Bowen observed that, within a family, one member often manifested the family’s underlying tension or dysfunction, usually through emotional or behavioural symptoms, while the rest of the family remained unaware of or avoided the deeper issues. Later theorists and therapists, including Salvador Minuchin (structural family therapy) and Jay Haley (strategic therapy), expanded on the practical and therapeutic applications of this concept, often using the term “Identified Patient” to describe the scapegoated child or symptom-bearer.
In dysfunctional families, the Identified Patient is also described as the scapegoated child, who draws attention away from unresolved conflicts, painful histories, or fragile family bonds. Historically, this behaviour was pathologised, seen as the “issue” to be corrected. New frameworks, including the Power-Threat-Meaning model (Johnstone & Boyle, 2018), invite us to understand these behaviours differently: not as signs of pathology, but as meaningful survival responses to the child’s circumstances and environment. In this light, the Identified Patient is no longer the “problem,” but rather the one expressing what the whole family system cannot say aloud.
Therapists today are increasingly aware of these dynamics. Rather than being pulled into the family’s collusion, siding with the narrative that the child is the problem, modern therapy invites a wider lens. We now ask: What role is this child playing for the system? What pain are they holding? What survival strategies are being misread as dysfunction? To reframe the Identified Patient is to move from blame to understanding, from pathology to context, from seeing a “problem child” to seeing a child who carried the family’s pain. It is an act of compassion, but also of clarity: a reminder that what appears to be disruption reveals the previously unspoken truths of a family’s hidden wounds. Particularly in families where compliance and conflict-avoidance dominate. Modern therapy builds on Bowen’s insight by focusing not on blaming the individual but on understanding the systemic forces that shaped their experiences and creating awareness that supports both the individual and the family as a whole.
Supporting the Child Who Carries the Family’s Pain: How Therapy Can Help
As children who have carried the weight of family pain grow into adulthood, they often carry patterns of hypervigilance, self-doubt, or feelings of invisibility. Coming to therapy as an adult can be a gentle turning point, a space to pause, reflect, and recognise the ways family dynamics shaped their early experiences. In this supportive environment, they can begin to separate their own identity from the roles they were asked to play, understand the systemic roots of past struggles, and explore new ways of relating to themselves and others with curiosity and compassion. Therapy becomes not just a place to heal old wounds, but a space to reclaim agency, autonomy and imagine a life defined by understanding rather than blame.
For someone who has taken on the role of the scapegoat, or Identified Patient (IP), therapy can offer more than coping strategies; it can be a space of recognition and growth. Counselling that combines systemic awareness, embodied techniques, and person-centred principles offers a gentle yet powerful way to support someone who has carried the family’s pain as an Identified Patient. By exploring the family system, clients can understand that their emotional responses were often adaptations, not personal failings. Embodied practices help them reconnect with their body, release stored tension, and regulate intense emotions, while the person-centred approach creates a space of genuine empathy and validation. Together, these approaches help clients feel seen, understood, and empowered, allowing them to reclaim their sense of self and navigate relationships with greater resilience and compassion.
Therapists work to validate the client’s experience. The IP often carries feelings of invisibility, blame, or ongoing rejection. Simply being heard and acknowledged can be profoundly healing. Rather than focusing solely on the individual’s behaviour, therapy explores the wider family context, helping clients see how their responses might have been shaped by unresolved tensions, emotional neglect, or family patterns. In this process, the concept of the actualising tendency (Rogers, 1961) becomes meaningful. It frames the client not as “the problem” but as a person with an innate capacity to grow, heal, and redefine their relationships, even in the face of past scapegoating.
For someone who has carried the family’s pain as an Identified Patient, counselling can offer more than coping strategies; it can be a space of recognition and growth. Therapists help clients see that their emotional responses were often adaptations to family patterns, not personal failings. Techniques that combine systemic awareness, embodied practices, and person-centred principles allow clients to reconnect with their body, regulate emotions, and feel genuinely seen and understood.
The concept of an actualising tendency, our natural drive to grow and heal, is central. While this idea is hopeful, critics remind us that family experiences, past trauma, or ongoing stress can create real barriers to growth (Christopher & Slife, 2003; Kirschenbaum & Henderson, 1989). Therapy works by acknowledging these barriers while providing tools, support, and understanding, helping clients reclaim their sense of self, rebuild confidence, and navigate relationships with greater resilience and compassion. Combining this perspective with family systems thinking offers a more realistic and compassionate approach. It allows clients to recognise their own resilience, understand the patterns that contributed to their IP role, and develop healthier boundaries and self-compassion.
Importantly, modern therapy does not collude with the family narrative that the child is “the problem.” By centering the client’s lived experience, therapists can gently explore patterns of blame, dysfunction, and unspoken grief, while supporting the individual in reclaiming agency over their emotional life. For adults with ADHD, rejection sensitivity, or trauma histories, this approach can be particularly affirming, helping them separate their identity and worth from the roles they were asked to play in their family system.
Ultimately, counselling is not about fixing. It’s about witnessing, offering another perspective, and supporting growth, building a pathway from invisibility and blame toward recognition, self-understanding, and empowerment.
Practical Takeaways
Therapy for someone who has been an IP is not about “fixing” them; it is about witnessing, contextualising, and empowering.
Clients learn to:
- Recognise patterns of family blame or dysfunction
- Develop healthier boundaries and self-compassion
- Reclaim their identity and emotional agency
- Navigate relationships with awareness and resilience
By shifting the lens from blame to understanding, therapy helps transform the experience of invisibility into one of recognition and growth.
From Invisibility to Recognition
The journey of an Identified Patient is often complex and challenging, but modern therapeutic approaches offer validation, insight, and support. Understanding that the child who carried the family’s pain was responding to systemic dynamics, not failing, is a powerful step toward self-compassion and emotional freedom. Therapy provides a safe space to untangle these patterns, reconnect with one’s body and mind, and reclaim a sense of agency, offering a path from invisibility to genuine recognition.
- Bowen, M. (1978). Family therapy in clinical practice. Jason Aronson.
- Bowen, M. (1976). Theory in the practice of psychotherapy. In P. Greenacre (Ed.), The psychoanalytic study of the child (Vol. 31, pp. 79–138). International Universities Press.
- Christopher, J. C., & Slife, B. D. (2003). The ideological roots of humanistic psychology. The Humanistic Psychologist, 31(2), 45–61. https://doi.org/10.1080/08873267.2003.11407972
- Haley, J. (1976). Problem-solving therapy. Jossey-Bass.
- Johnstone, L., & Boyle, M. (2018). Power, threat, and meaning: Understanding psychiatric diagnosis. Routledge.
- Kirschenbaum, H., & Henderson, V. L. (Eds.). (1989). The Carl Rogers reader. Houghton Mifflin.
- Minuchin, S. (1974). Families and family therapy. Harvard University Press.
- Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Houghton Mifflin.
