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Indications for either individual therapy or family therapy as treatments of first choice are identified at the initial family assessment. A family approach is suggested in (1) scapegoating systems where the symptom is essential to the family homeostasis; (2) enmeshed families where communications are confused and diffuse; (3) paranoid‐schizoid families where the family denies the symptoms and (4) families in a current acute shared crisis. Individual treatment is indicated when (1) the patient has suffered traumatic separations; (2) separate help is asked for; (3) the therapist considers individuation necessary and (4) unusual life experience. Clinical examples are given.

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