The practicing pediatrician faces many situations in the management of patients where tensions and conflicts in the family constellation contribute to the illness itself and frustrate his efforts at treatment. His ability to deal with the family "illness" as part of his total treatment plan will probably depend more on experience he has gained through trial and error than through systematic training in medical school or the residency years. As a result, many pediatricians, as well as other medical practitioners, may be inept in their efforts at family or marriage counseling, or avoid it altogether.