Much of the prior research on the psychosocial aspects of end stage renal disease (ESRD) has focused solely on the individual, without considering the family's role in patient adjustment. Little research has been conducted on the contextual elements of the patient's adjustment to renal failure and dialysis. It was the purpose of this study to assess the effect of family relationships on a patient's health locus of control as a measure of adjustment to ESRD. Health locus of control was hypothesized to be dependent on the family relationship variables of cohesiveness, adaptability and independence; as well as a communications variable measuring incongruent communications. From the general context of the double bind a path model was constructed to estimate the associations among the variables. Data was collected and analyzed on 91 ESRD patients from four dialysis treatment centers and a sample of Continuous Ambulatory Perotineal Dialysis patients. The results of this research suggest that the double bind theory may be an excellent explanatory paradigm for patient adjustment to chronic illness. It was found that the greater the perceived paradox in family communications the more likely the patient was to subscribe to an externally oriented health locus of control. The family relationship variables were found to be indirect predictors of health locus of control, acting through the family communications process. / Ph. D.