The Body Responds to Relationships: Why Therapy Must Look Beyond the Individual
- Patrizia Nader
- 1 day ago
- 6 min read
(Why I Practice Integrative Systemic Family Therapy)
What if the symptom we see in the individuals is telling us something about the system/ context that surrounds them?
Most therapists, often trained to look at the behavior of individuals alone and inward, asking what is happening inside (What are they thinking? What are they feeling? What happened to them? What beliefs are maintaining the problem? What needs to change within them?)
These are important questions.
But sometimes they are not enough.
Sometimes, to understand what is happening inside a person, we have to look at what is happening between people.
One of the most compelling examples of this comes from the work of psychiatrist Salvador Minuchin, endocrinologist Lester Baker, psychologist Bernice Rosman, and their colleagues in the 1970s. Their research examined children with psychosomatic illness, including diabetes, while simultaneously observing the interactions taking place within their families.
One family in particular has stayed with me: the Collins family.
Two sisters in the family had diabetes. Both were living within the same family environment, with the same parents and many of the same relational experiences. Yet when researchers observed the family interacting and measured physiological changes in the children’s blood, the girls did not respond in the same way.
Their bodies were telling different stories.
The researchers were interested in more than whether the children were psychologically distressed. They were interested in what happened physiologically as family interactions unfolded.
This is where the research becomes particularly profound.
The family interaction itself became part of the physiological environment.
The body was responding not simply to an isolated event, but to a relational context.
The symptom belongs to the individual, but the context may belong to the system
We often refer to someone in therapy as the “identified patient.”
The person has the anxiety.
The teenager has the eating disorder.
The child has the behavioral problem.
The adult has the panic attacks.
The person has the chronic pain.
The child has the illness.
And because the symptom is visible in one person, we naturally begin by focusing our attention there.
But systemic therapy asks us to widen the lens.
Instead of asking only, “What’s wrong with this person?” we begin asking:
What is happening around this person?
Who responds when the symptom appears?
How do they respond?
What happens between family members immediately before and after an episode?
Who becomes anxious?
Who becomes protective?
Who withdraws?
Who takes control?
Who mediates?
Who becomes responsible?
Who gets blamed?
Who becomes the “strong one”?
Who becomes the “problem”?
And perhaps most importantly:
What happens to the family system when the symptom appears?
These questions do not mean that the family caused the illness.
That distinction is essential.
Diabetes is not caused by a parent arguing with a child. Depression is not simply caused by a difficult marriage. Autoimmune disease is not evidence of dysfunctional parenting.
The danger of a simplistic psychosomatic explanation is that it can turn a complex interaction into blame.
That is not the point.
The point is that biological vulnerability exists within relational environments.
And those environments can influence physiological arousal, coping, symptom expression, illness management, and the way an illness unfolds over time.
The body doesn’t experience relationships as ideas
We sometimes speak about emotional stress as though it were separate from the body.
We say, “That relationship is stressful,” as though stress were simply a thought occurring in the mind.
But the nervous system doesn’t experience relationships as abstract concepts.
It experiences them through physiology.
Heart rate changes.
Breathing changes.
Muscles tense.
Hormones shift.
Attention changes.
The body prepares for connection, protection, withdrawal, or defense.
Our relationships become part of the environment in which our nervous system operates.
This is why the Collins family research is so fascinating. The researchers weren’t merely asking the children how they felt about their family. They were measuring physiological changes while the family was interacting.
In other words, they were asking:
What happens in the body when this family comes together?
That is a very different question from simply asking what is happening inside the individual.
Every family develops a pattern
Families are systems.
And like all systems, they develop patterns.
Over time, people fall into roles.
One person becomes the caretaker.
One becomes the mediator.
One becomes the responsible child.
One becomes the rebel.
One becomes the peacemaker.
One becomes the emotional center of the family.
And sometimes one person becomes the identified patient.
These roles are rarely consciously chosen.
They emerge through thousands of interactions.
A child learns that when Mom and Dad fight, they need to intervene.
Another learns that expressing anger creates too much disruption, so they become quiet.
Another learns that being sick brings everyone together.
Another learns that achievement keeps the family calm.
Another becomes responsible for everyone’s emotional wellbeing.
Eventually, these patterns can feel like personality.
“She’s just anxious.”
“He’s the difficult one.”
“She’s the sensitive child.”
“He’s the strong one.”
But systemic therapy invites us to become curious about how those identities developed.
What role does this person play in the emotional organization of the family?
And what happens if they stop playing it?
Sometimes the symptom becomes part of the family dance
This is one of the most important, and most easily misunderstood ideas in systemic therapy.
A symptom can become woven into the family’s pattern of interaction.
Again, this does not mean that someone consciously creates a symptom.
It does not mean a child chooses to become ill.
It does not mean a parent deliberately creates anxiety.
And it certainly does not mean that a person is responsible for their own illness.
It means that once a symptom exists, the family adapts around it.
And that adaptation can create new patterns.
A child’s illness may cause a parent to become increasingly protective.
The parent’s increased protection may cause the child to feel less capable.
The child’s dependence may increase the parent’s vigilance.
The parent’s vigilance may increase the child’s sense that the world is unsafe.
And the cycle continues.
No one person has necessarily created the cycle.
The cycle itself has become the problem.
That is a profoundly different way of thinking about therapy.
Why the individual may not be the whole story
Imagine treating a child for anxiety while sending that child home every night to a relational environment that continually activates the very patterns you are trying to change.
You may teach the child breathing exercises.
Cognitive restructuring.
Emotion regulation.
Distress tolerance.
But what happens when they walk back through the front door?
What happens when their parents begin fighting?
What happens when one parent becomes emotionally dependent on the child?
What happens when the child’s anxiety is the only thing that brings both parents into the same room?
The child may become better at managing anxiety without anything changing about the system that continually generates the conditions in which the anxiety flourishes.
This is where systemic therapy offers something essential.
It doesn’t simply ask the individual to adapt better.
It asks whether the relationships themselves need to change.
Looking for the root means widening the lens
We often talk about getting to the “root” of a problem.
But perhaps the root isn’t always buried inside the individual.
Sometimes the root is found in a pattern.
A relationship.
A boundary.
A role.
A loyalty.
An unresolved conflict.
A family rule that has never been spoken aloud.
A pattern of protection that has gradually become restriction.
A pattern of conflict that everyone has learned to avoid.
Or a pattern in which one person’s symptoms regulate the emotional temperature of everyone else.
The individual is not removed from the picture.
Quite the opposite.
We understand the individual more fully when we understand the context in which the individual lives.
This is why systemic therapy matters
A systemic therapist doesn’t stop asking about the individual.
They simply refuse to assume that the individual exists in isolation.
We can ask about attachment, trauma, cognition, physiology, behavior, and emotion and simultaneously ask about relationships, boundaries, roles, communication, power, patterns, and feedback loops.
We can ask:
What is happening inside this person?
And:
What is happening between these people?
Both questions matter.
Perhaps the most complete formulation is not person versus family, or biology versus psychology, or individual versus environment.
It is an understanding of how these systems interact.
Because human beings are relational organisms.
We develop in relationship.
We regulate in relationship.
We are wounded in relationship.
And we heal in relationship.
The lesson from the Collins family and the broader work of Minuchin and Baker is not that families cause illness.
It is something much more nuanced and, I believe, much more hopeful:
The body exists within a relational world.
And when we are trying to understand suffering, sometimes we need to stop looking only at the person carrying the symptom and start looking at the system carrying the relationship.
The symptom may be located in one person.
But the story may be much bigger than one person.
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