The concept of the nuclear family emotional system describes four basic relationship patterns that govern where problems develop in a family. People’s attitudes and beliefs about relationships play a role in the patterns, but the forces primarily driving them are part of the emotional system. The patterns operate in intact, single-parent, step-parent, and other nuclear family configurations.

Clinical problems or symptoms usually develop during periods of heightened and prolonged family tension. The level of tension depends on the stress a family encounters, how a family adapts to the stress, and on a family’s connection with extended family and social networks. Tension increases the activity of one or more of the four relationship patterns. Where symptoms develop depends on which patterns are most active. The higher the tension, the more chance that symptoms will be severe and that several people will be symptomatic.

The four basic relationship patterns are:

Marital conflict – As family tension increases and the spouses get more anxious, each spouse externalizes his or her anxiety into the marital relationship. Each focuses on what is wrong with the other, each tries to control the other, and each resists the other’s efforts at control.

Dysfunction in one spouse – One spouse pressures the other to think and act in certain ways and the other yields to the pressure. Both spouses accommodate to preserve harmony, but one does more of it. The interaction is comfortable for both people up to a point, but if family tension rises further, the subordinate spouse may yield so much self-control that his or her anxiety increases significantly. The anxiety fuels, if other necessary factors are present, the development of a psychiatric, medical, or social dysfunction.

Impairment of one or more children – The spouses focus their anxieties on one or more of their children. They worry excessively and usually have an idealized or negative view of the child. The more the parents focus on the child the more the child focuses on them. He is more reactive than his siblings to the attitudes, needs, and expectations of the parents. The process undercuts the child’s differentiation from the family and makes him vulnerable to act out or internalize family tensions. The child’s anxiety can impair his school performance, social relationships, and even his health.

Emotional distance – This pattern is consistently associated with the others. People distance from each other to reduce the intensity of the relationship, but risk becoming too isolated.

The basic relationship patterns result in family tensions coming to rest in certain parts of the family. The more anxiety one person or one relationship absorbs, the less other people must absorb. This means that some family members maintain their functioning at the expense of others. People do not want to hurt each other, but when anxiety chronically dictates behavior, someone usually suffers for it.


The tensions generated by Michael and Martha’s interactions lead to emotional distance between them and to an anxious focus on Amy. Amy reacts to her parents’ emotional over involvement with her by making immature demands on them, particularly on her mother.

Analysis: A parent’s emotional over involvement with a child programs the child to be as emotionally focused on the parent as the parent is on the child and to react intensely to real or imagined signs of withdrawal by the parent.

When Amy was four years old, Martha got pregnant again. She wanted another child, but soon began to worry about whether she could meet the emotional needs of two children. Would Amy be harmed by feeling left out? Martha worried about telling Amy that she would soon have a little brother or sister, wanting to put off dealing with her anticipated reaction as long as possible. Michael thought it was silly but went along with Martha. He was outwardly supportive about the pregnancy, he too wanted another child, but he worried about Martha’s ability to cope.

Analysis: Martha externalizes her anxiety onto Amy rather than onto her husband or rather than internalizing it. Michael avoids conflict with Martha by supporting the focus on Amy and avoids dealing with his own anxieties by focusing on Martha’s coping abilities.

Apart from her fairly intense anxieties about Amy, Martha’s second pregnancy was easier than the first. A daughter, Marie, was born without complications. This time Michael took more time away from work to help at home, feeling and seeing that Martha seemed “on the edge.” He took over many household duties and was even more directive of Martha. Martha was obsessed with Amy feeling displaced by Marie and gave in even more to Amy’s demands for attention. Martha and Amy began to get into struggles over how available Martha could be to her. When Michael would get home at night, he would take Amy off her mother’s hands and entertain her. He also began feeling neglected himself and quite disappointed in Martha’s lack of coping ability..

Martha had done some drinking before she married Michael and after Amy was born, but stopped completely during the pregnancy with Marie. When Marie was a few months old, however, Martha began drinking again, mostly wine during the evenings, and much more than in the past. She somewhat tried to cover up the amount of drinking she did, feeling Michael would be critical of it. He was. He accused her of not trying, not caring, and being selfish. Martha felt he was right. She felt less and less able to make decisions and more and more dependent on Michael. She felt he deserved better, but also resented his criticism and patronizing. She drank more, even during the day. Michael began calling her an alcoholic.

Analysis: The pattern of sickness in a spouse has emerged, with Martha as the one making the most adjustments in her functioning to preserve harmony in the marriage. It is easier for Martha to be the problem than to stand up to Michael’s diagnosing her and, besides, she feels she really is the problem. As the pattern unfolds, Michael increasingly over functions and Martha increasingly under functions. Michael is as allergic to conflict as Martha is, opting to function for her rather than risk the disharmony he would trigger by expecting her to function more responsibly.

By the time Amy and Marie were both in school, Martha reached a serious low point. She felt worthless and out of control. She felt Michael did everything, but that she could not talk to him. Her doctor was concerned about her physical health. Finally, Martha confided in him about the extent of her drinking. Michael had been pushing her to get help, but Martha had reached a point of resisting almost all of Michael’s directives. However, her doctor scared her and she decided to go to Alcoholics Anonymous.

Martha felt completely accepted by the A.A. group and greatly relieved to tell her story. She stopped drinking almost immediately and developed a very close connection to her sponsor, an older woman. She felt she could be herself with the people at A.A. in a way she could not be with Michael. She began to function much better at home, began a part-time job, but also attended A.A. meetings frequently. Michael had complained bitterly about her drinking, but now he complained about her preoccupation with her new found A.A. friends. Martha gained a certain strength from her new friends and was encouraged by them “to stand up” to Michael. She did. They began fighting frequently. Martha felt more like herself again. Michael was bitter.

Analysis: Martha’s involvement with A.A. helped her stop drinking, but it did not solve the family problem. The level of family tension has not changed and the emotional distance in the marriage has not changed. Because of “borrowing strength” from her A.A. group, Martha is more inclined to fight with Michael than to go along and internalize the anxiety. This means the marital pattern has shifted somewhat from dysfunction in a spouse to marital conflict, but the family has not changed in a basic way. In other words, Martha’s level of differentiation of self has not changed through her A.A. involvement, but her functioning has improved.