Family Therapists Have A Name For The Family Member Who Is 'Always The Problem'

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

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 behavior, emotions, or symptoms are seen as the root of the family’s distress.

But as family therapists emphasize, 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 behaviors, 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 behaviors 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.”