In many families, there’s a shared but unspoken understanding about who they collectively consider “the problem”.

It might be the teenager acting out, the parent with depression or the sibling struggling with addiction. In clinical terms, that person is often called the “designated patient” or “identified patient” – the individual whose behaviour, emotions, or symptoms are seen as the root of the family’s distress.

But as family therapists emphasise, this role rarely forms in a vacuum. The designated patient is usually expressing — often unconsciously — something the family system as a whole can’t address directly. Their symptoms become the family’s signal flare.

“In typical family therapy sessions, the term ‘designated patient’ or ‘identified patient’ is used to describe the member of the family whose behaviours, emotions, or symptoms are problematic for the family,” said Dr. Jeffrey Ditzell, a New York-based psychiatrist. “Often the family will be seeking therapy as a result of this member’s maladaptive behaviours or issues.”

He adds that focusing on one member can obscure a larger truth: “In most cases, the distress of the designated patient is a possible signal of stress, dysfunction, or inequity within the entire family system.”

That means the “problem person” isn’t necessarily sick — they might simply be the one expressing pain on behalf of everyone else.

A Symptom Of The System

Family systems theory, developed in part by psychiatrist Murray Bowen in the mid-20th century, holds that families function as interdependent emotional units. In this framework, one person’s anxiety, anger or depression doesn’t belong only to them — it reverberates through the entire group.

“The term ‘designated’ or ‘identified patient’ refers to the member of the family who holds and acts out the stress of the family system,” said Emily Waitt, LMFT and founder of Kincove, a Los Angeles-based adolescent mental health center. “This person is often........

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