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The patient who comes to us for treatment of his neurosis is the child of his parents. Probably he has siblings. In most cases he grew up among these members of his family and has been surrounded by them for much of his life; his interpersonal relations were and still are conditioned by their behavior, their actions and reactions. The therapeutic isolation of the patient on the couch is an artificial situation, alien to the life situation from which he comes and to which he returns.
It is hardly an exaggeration to say—and most experienced psychotherapists will concur with me in this—that it is rarely the individual patient alone who is sick, but usually the entire family group to which he belongs. Carl Binger calls the family an “unvoluntary social aggregate dominated by its sickest member.” Whatever may be the hereditary, constitutional and endocrine components of the patient's condition, his disturbance is essentially the functional result of his family's maladjustment.
To disregard the existence of this family, then, while we treat the individual, means in this sense to leave him exposed to chronic reinfection. We can of course argue that our aim, especially in any psychoanalytically oriented form of therapy, is precisely to immunize him against these influences. It is within the family situation, we may say, that he must learn to speak, act and comport himself as an adult, by giving up the infantile dependency which is rooted in his reactions to his childhood world and has then been transferred to other people. To be sure, in many cases we shall be able to reach this goal, at least to a certain degree. With the aid of continuous comments by the therapist, gradually the patient will come to understand the transference of his infantile behavior from the original objects to his mate, his employer, or other parental images. Eventually his growing insight will enable him to achieve the desired deep-going and durable changes in his reactions and behavior.
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