When there’s a ‘problem’ child, what is going on in the rest of the family?

 29 December 2025

 How do we approach things when we’re told there is a ‘problem’ child who needs to be treated? Often we will focus on the child (or children) and the problem they are presenting - such as school refusal, aggression, anxiety, self-harm, addiction or some other issue.

 We may also be interested to consider if there is some kind of neurological or mental health issue that needs to be assessed, such as autimsm or ADHD.

 It can be very easy to simply focus on the child, or chldren/young people, who are presenting the problem issue. But there is a therapeutic approach, known as systemic family therapy, which instead looks at the whole family and what else may be going on that may be relevent. 

The ‘identified patient’

 When a child/young person is presented as the person with the problem, who needs fixing, they are referred to by systemic therapists as ‘the identitfied patient’ (IP). What this means is that, from the parents’ viewpoint it is the child who is the problem. A systemic therapist will be interested in who else, apart from the IP, is contributing to the unwanted behaviour.

 A systemic approach looks at the family as a ‘system’. What this means is that there is a constant flux of action and reaction among different family members, which is having an impact on each person. The systemic therapist seeks to understand how the family system works and whether the child’s ‘problem’ behaviour is, at least in part, a reflection of wider issues in the family.

 A common issue is where the relationship between the parents is poor and the child begins to behave in a problematic way. It may be that the child’s behaviour is an unconscious attempt to get the parents to focus on him or her rather than fighting with each other. In this sense the child is sacrificing themselves for the good of the family. Of course, none of this is conscious or intentional but it can nevetheless present the therapist, or other practitioners seeking to support the family, with a major challenge if they focus simply on the child and ignore the other issues.

 For example, it may be that the relationship between the parents has become strained over time. Perhaps one parent, often but not always the father, isn’t around that much and the other, often but not always the mum, feels left on her own to deal with the children. In that scenario there can be an ‘enmeshment’ between mum and the child, which means that the boundaries between the two of them become more hazy and less firm, as mum gets more of her emotional needs met from the child. 

Family alliances

 In that situation, if the child is exhibiting p;roblematic behavour of some kind, dad (who is feeling excluded by the ‘allaince’ between mum and the child),  may become overly punitive towards the child. This in turn evokes mum’s protectiveness towards the child, which makes dad feel more excluded, and the cycle goes round and round. 

 Often these kinds of family problems are when one or more of the children begin to occupy a place in the family that is where only the parents should be. In other words, the child has become too powerful. This power may be reflected in the fact that the parents have backed off challenging the child because they are afraid of the consequences, or also in the fact that the child may have a disproportionate influence over one of the parents at the other parent’s expense. 

Boundaries

 An important area that will be looked at in systemic family therapy is boundaries. These can be healthy, rigid or porous. What sometimes happens is that one parent will have porous boundaries with the child, which means the parent/child relationship is more like a friendship than an adult/child relationship. Rigid boundaries mean that there is a lack of warmth or connection between the parent and child. 

 Communication is another important issue in this area. Families where there are problems have often developed habits of communicating that are indirect rather than direct. There may also be patterns around which family members talk to each other about certain topics and which members feel they need to go through another family member in order to get their message across. 

 How confllict is expressed

 Also, a big issue is how is conflict handled. Is it ok for there to be conflict or do things get very heated very quickly. Alternatively, in some families conflict is not really allowed at all. Instead the conflict goes ‘underground’, in other words it is expressed indirectly rather than being out in the open. Or perhaps one parent often speaks on behalf of one of the children, which suggests porous boundaries are an issue.

 In systemic language we can find that one member of the family (often the child/young person) is manifesting, or ‘carrying’, a particular emotion. Common emotions in this situation are anger, anxiety or depression. With further investigation it may turn out that the relevant emotion is suppressed by the parents, perhaps because they themselves grew up in families where it was not acceptable to show anger, anxiety or depression. But the suppression of the emotion does not mean it simply disappears. Instead it becomes concentrated in the ‘identified patient’, who then becomes the problem. 

 The value of a systemic approach is that we look beyond the symptom that is being expressed by the child/young person. Instead of focusing all our energy on trying to ‘fix’ them we look more broadly at the family dynamics and relationships. This does not mean that there may relevent neurologivcal or mental health issues that need to be assessed and treated, but that frequently it is more complicated than that. 

 It is also important to get away from the idea of blaming any one inidividual, or even the family as a whole. The point is that the dysfunctional behaviour is an unconscious way that members of the family are trying to get their needs met and also, in some way, serve the needs of the wider family - they are just doing it in a way that creates bigger problems than it solves.