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Moving Beyond the Role of Identified Patient

Part 2: What an Identified Patient can look like, and their healing tasks.

Key points

  • In practice, being the Identified Patient can take on a variety of forms.
  • Healing from the impacts of being made to play this role is possible with learning, awareness, and assertiveness.
  • A cornerstone task of moving beyond the role is learning how to set better boundaries.

In my previous post, we explored what and who the identified patient is in a family system in theory. Today, I want to share examples of what this role can look like and explore the specific healing tasks an identified patient may face.

There are as many iterations of what it can look like to be the Identified Patient of a family system as there are unique families, but here are a few examples of how this Identified Patient archetype may manifest:

  • [Parent to teen] “You’re so angry all the time! What’s wrong with you? You’re such a mean older brother. Why can’t you just be nice like your sister?”
  • [To the family counselor] “Savannah’s high all the time and she’s failing most of her classes. We just don’t GET it. Her sister was the valedictorian, senior class president, and she just got into Stanford. We don’t understand why Savannah can’t act like her sister.”
  • [To the child] “Dad’s just being Dad. That’s just how he is. He’s just joking when he says things like that. You shouldn’t be so sensitive. You’re such a snowflake.”
  • [To the therapist] “We just don’t know where we went wrong with Sam. Both of us went to Ivies, my wife is the first female CEO at her firm, our house is covered in books, and all he wants to do is sit in his room and play video games with friends he doesn’t even know in real life. It’s like he’s not even our child.”

In each of these scenarios, one person is maligned for their experience, and seen as being “wrong” somehow for acting, thinking, and feeling the way that they do. This – being targeted and made wrong even if in the so-called service of trying to help you – is a hallmark of an Identified Patient’s experience.

Can things change? Will someone always be the Identified Patient of their family? There is always the possibility for change, even in dysfunctional family systems. Family systems are living, breathing, things, and all dynamic systems and organisms have the possibility to change.

Sometimes this means the system itself gets healthier, like when, ideally, a whole family gets into therapy with a truly great family counselor and does the hard and generationally impactful work of seeing what is and developing tools to function more healthily and responsibly. Sometimes this change occurs when the Identified Patient removes themself (or distances themselves) from the system in order to get healthier.

If you are the Identified Patient of your family system, you don't have to remain in that role objectively and forever. You have options in both how you perceive yourself, and how your family perceives you and functions as a whole. When it comes to taking care of yourself, you have choices.

Consider the idea that a family system – be it healthy or dysfunctional – has a certain kind of dance going on. Locked in step, the unit “dances” a certain way, everyone doing the steps they know, the ones they’ve been unwittingly trained to do. Now, in an ideal world, would we get a dance teacher in there to choreograph new and better steps for the whole unit? Of course. This is ideally what family therapy is about.

But consider this, too: In a dance, any kind of dance, if one person changes their steps, the dance changes. So, if you see yourself fitting the Identified Patient description but there’s no way your family (at least at this time) is going to go to counseling, remember that you still have some agency and control. You can be the person who changes your dance steps, and when you do, even if others don’t, something about the dance will change.

If you identify as the Identified Patient and want to take better care of yourself, consider that the biggest way you can change your steps is through psychoeducation — learning about what is going on in your family system and then learning about and implementing boundaries, about how you see yourself, how you let others speak about you or treat you, and the proximity you'll allow to, or the distance you'll maintain from, a system that’s not healthy and supportive for you.

You can best take care of yourself by clarifying your boundaries, learning how to assert them, and then taking care of yourself when faced with the ensuing responses of others. Learning how to recognize, clarify, assert, re-assert, and re-negotiate personal boundaries with challenging people (especially in our family of origins or the families we marry into) is a huge, complex, and highly emotional challenge.

I encourage you to reach out to as many supports as possible in order to get the help you need to process your experience and better learn how to set boundaries within your dysfunctional family system. Therapy is a good option, and the Psychology Today Therapy Directory has an extensive directory of therapists for you to choose from.