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Intrafamilial disappointment, hostility, and guilt are inevitable, and in a healthy family the capacity to cope with such feelings depends on each member's ability to express his reactions. In an unhealthy family, members deny and repress these emotions until a crisis makes them unbearable; then they are projected onto another member, the scapegoat. The scapegoat's subsequent behavior is the expression of these projections and establishes a pathological equilibrium. An impending death severely strains the family emotions, especially when the dying person is unaware of his fate. Grief, helplessness, and resentment toward the dying cannot be ventilated and a myth, often unconscious, is engendered that blames the scapegoat for the family distress.
In multiple family group therapy, combining family and stranger therapy, each family empathizes with the emotional realities of other lives. Members of a different family act as co-therapists by offering analogous experiences. As hitherto hidden circumstances are exposed, members tell of their denied emotions, encouraged by witnessing similar guilt, rage, and resentment in other family units. Such ventilation fosters heightened self-awareness and self-esteem, while the behavior that results in anxiety is understood better.