The concept of “Identified Patient” suggests that someone in the family system, say a child, having behavioral problems, is often signaling that something in the family system is problematic. In many cases it has been noted that in a family system with several children, whenever one child’s issue improved, usually because of being sent to see a therapist, one of the other siblings would start manifesting symptoms.
This kind of change was referred as 1st order change which usually amounted to the child following the rules and expectations set before him/her. Getting back in line more or less but not addressing underlying resistances to the change. 1st order change is heavily noted for having a high failure rate.
Second order change was termed “the difference that makes a difference” and has always been considered necessary if change had a chance of being a lasting change. Therapy examined how the family system’s rules and expectations contributed to the problem in the Identified patient and the family members, whenever possible stayed open to making the changes deemed important for second order change to occur.