A family is a system, meaning each member affects the other. A system has many moving parts, and a family is a good example of a system that has strengths and weaknesses within the system. Understanding how everyone affects everyone else is the core concept of systems therapy, a therapeutic approach that can be helpful in understanding the complex dynamics of the family challenged by OCD.

A family systems approach encourages parents and children to look at the behavior of everyone in the family, rather than limiting focus to the individual family member who may be experiencing difficulty, in this case OCD, at any given time. Most families, with or without OCD or another mental health issue in a child, unconsciously assign one child as its “good child” while another is assigned the role of “problem child,” or “black sheep.” Most likely, these roles will change from time to time inside families.

Systems therapy can be a valuable lens through which to learn how a family system works, or doesn't when roles are assigned in this manner, especially when one child in a family has a mental health disorder such as OCD. In these cases, this child will often receive the majority of the attention in the family, both positive and negative, leaving other siblings feeling neglected and resentful.

Stuck in the manufactured role of “problem child” and after a lengthy period of being viewed (consciously or unconsciously) as the primary source of the family's problems, the child with OCD can end up feeling trapped, and less inclined to commit to change through treatment.

Other siblings can get similarly trapped in the role of the “good” or “perfect child,” making it hard for them to experience the normal ups and downs of growing up. It becomes the parent's role to deal with this system and gradually teach both the child with OCD and the other child how to deal with the problems brought about by a sibling's OCD, without putting any child into a box from which it will be hard to escape.