The Fifth Wheel & Family Therapy, This Is Us, Episode 11

I love family therapy. I simply love it. Why? Because the gloves come off in family therapy! Usually, in individual therapy, the client is on their best behavior. A teen alone will say that they are “always” respectful to their parents and a parent will explain how they just want the best for their children. But in family therapy? When the whole family is face to face? They can’t fake the funk for long.

The Pearson’s are back. And so I’m back also, having fun thinking psychological things while I watch this TV family. This time we get to watch a family therapy session with Kevin while he’s in rehab. We get to see how each of the family members feels about going and we’re treated to the “passive aggressive sigh” from Beth since she did NOT want to be there (she warned us she’d do it!). The Outsiders (or The New Big Three) were kicked out, but had a good heart to heart and were able to bond over not fully understanding the family trauma. I loved the little joke This Is Us poked at itself by Randall wishing their lives were documented like the film “Boyhood”… because it is (for us)! But I wonder how Randall would have reacted to that scene where Kevin was left alone while the others were sharing a bed at the cabin …it was downright painful to watch. I have to say however, that Randall was right to point out that if Kevin didn’t have as much money as he did, that DUI would have landed him in jail rather than the fancy schmancy rehab facility. #classismsucks Randall picked the wrong place and the wrong tone to bring all that up, but hey, that’s the beauty of family therapy.

You Can’t Fake It in Family Therapy

I love family therapy. I simply love it. Why? Because the gloves come off in family therapy! Usually, in individual therapy, the client is on their best behavior. A teen alone will say that they are “always” respectful to their parents and a parent will explain how they just want the best for their children. But in family therapy? When the whole family is face to face? They can’t fake the funk for long. Before you know it, the teen is cursing at the parents and the parent is yelling and threatening to kick the child out on the street. And that’s when I sit back with an evil smirk on my face and my fingertips together like “Yessss… yesss… let the truth emerge.” If only I had a little cat to pet in those moments.

But seriously, this really is the beauty of family therapy – true family dynamics emerge and the therapist can better evaluate what “really” goes on at home. The therapist can also jump in and highlight those dynamics and work on changing them. Technically, family therapy should be a weekly thing, not a one-time event as it seems was done for Kevin. There just isn’t enough time to uncover all the truths and create healthier family interactions. We don’t get to see whether the family could really explore the feeling Kevin had of being the fifth wheel and how he said this created a voice in his head that he wasn’t “enough.” That was a huge discovery to share! Kevin is not only saying he has not felt “enough” all of his life, but he’s now asking for his family to reassure him that he is – and they could not. And there certainly wasn’t enough time for Kevin and Rebecca to really dissect how poorly they communicated and understood each other. Rebecca felt Kevin was not “easy” to get along with and abandoned her after Jack died, and Kevin felt he was so unimportant that they didn’t even have a special “thing” together while Jack was alive. (in my last post I write about having a “thing” with your kid and how important it is!)

The Pearson’s would benefit from more family therapy, especially in this situation where Kevin is being viewed as the family f*ck up (can I say that in a blog?) and an addict, but everyone else is “fine.”

The Identified Patient Saves the Day

In family therapy, there is always an “Identified Patient.” This is the person the family has chosen (usually unconsciously) to be the holder of all that is bad and dysfunctional in the family. The person is somehow given a bag full of pain, shame and family secrets and then everyone gets to treat them like they have a problem. In some families, you may even hear family members tell this person how much better life would be if they weren’t there. They are often treated as an outsider and disconnected from many members of the family or from what’s going on within it. Identified Patients are seen as deficient in some way, can be the target of ridicule, can get stricter rules and punishments, are assumed to have done something wrong or can be ignored entirely. It is not uncommon for the Identified Patient to be the one who gets diagnosed with a disorder (like depression), be hospitalized for a suicide attempt, get suspended or expelled, get in legal trouble, or develop a substance abuse issue. Depending on how severe the maltreatment, the Identified Patient may just choose to leave the family altogether – by running away, going to a boarding school or out of state college, joining the armed forces or getting married. But the key here is that the Identified Patient is only reacting to all the dysfunction the family refuses to accept.

Does this sound like Kevin to you yet?? We see from childhood that Kevin was often kept at a distance from others, as if he wearing a shirt that said “Danger: Stay Away.” Kevin is left alone to eat, left alone in his room on vacation and then in high school he is left alone in the basement two floors away from everyone else. Filling his days and weekends with football served as a way to reinforce distance from the rest of the family. Then when Kevin makes (another) mistake or reacts to being ignored, the family gets the green light to remind him of the pain he (and the bag he carries) causes everyone.

And this is another reason why I love family therapy – in family therapy, the family f*ck up is viewed as a sort of a savior. The holder of the bag of pain and secrets becomes the holder of all truths that bring everyone closer. The “problem child” becomes the one brave enough to do something that finally gets everyone the help they have so desperately needed. So in this situation, although Kevin had been suffering openly for years, his DUI and possibly harming himself and Tess could be seen as a final act of bravery to get the family to wake up and talk about the secrets they refuse to share. If it were not for Kevin’s DUI with Tess in the car, the family would still not talk about Jack’s alcohol addiction, still not acknowledge that addiction runs in their family, and would not know how to acknowledge that Kate is struggling with her own food addiction. The Identified Patient is viewed as the one who is actually trying to save the family. I think that is a beautiful reframe that can make the Identified Patient see their own strength and resiliency and can cause the family to do some much-needed introspection.

The truth is, Kevin had been trying to tell the parents his feelings all his life. He would ask for his parent’s attention and when he didn’t get it, he would lash out at a sibling – most often Randall. Of course, then Kevin gets in trouble for targeting Randall and gets isolated yet again. He looked upset, he would sulk off alone, he would complain to anyone who would listen about his treatment. He even pushed alarm bells by saying things like “I hate you! This family sucks!” He spelled it out to Jack at the pool, saying he almost died because his father was too worried about whether Kate is eating too much and whether Randall was “too adopted.” They COULD NOT HEAR HIM. Kevin held the bag of all the things family wanted to repress and he disappeared along with it. Until now where Kevin put his own life in danger to try and get himself and his family some help.

What is the result? In just one session, Kevin was able to confront his sister about her likely binge eating disorder and get Kate to really think about how it might be related to her father. He was able to openly say that his father and grandfather had an alcohol addiction and it was time to address it. Most importantly, he was able to explain to his whole family how much pain being ignored and excluded caused him. This gave Rebecca the permission to finally express her own burdens of feeling rejected by Kevin, not knowing how to handle it, and then retreating to her “easier” relationship with Randall. Rebecca, who has made some questionable decisions as a mother was able to see something new that she didn’t want to see before. She thought all those years that she didn’t have to worry about Kevin – that he was “fine” – but she finally realizes he wasn’t ok and that in a way admitted she couldn’t face that she didn’t know how to reach him. She essentially validated the isolation Kevin always felt. And that means Kevin doesn’t have to carry around all that pain anymore because the family is beginning to pick up their own share.

And that, my friends, is the beauty of family therapy.

Do you wish we could see more family therapy sessions for the Pearsons? Are you trying to figure out who was the Identified Patient in your own family?

Speak Your Mind


3679 Motor Ave. #301
Los Angeles, Ca 90008
(310) 210-8748

Got Questions?
Send a Message!

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.