Work with the family ha traditionallly been claimed as the domain of social work within the hospital setting. The difficulties of expanding the scope of clinical work to systematically include the family and its needs as integral to meeting the patients' psychosocial needs can be attributed in part to the absence of a conceptual model that encompasses the patient, the impact of the illness, the family and the hospital. The authors propose a paradigm to address these multiple variables with their attendant treatment implication.