Families and Chronic Illness

Module Sections:

Treatment

Strategies

  • Gather the family’s history around this illness and other illnesses. This strategy is geared toward helping the family recognize interfaces 3 and 4, as presented in Figure 1.

Techniques

  • Draw a three-generation genogram of the family
  • Have family help you label family members with physical illnesses and/or mental health conditions
  • Ask patient who they relate to the most on the genogram
    • Ask the patient how they relate to that family member
  • Ask the family circular questions. This is meant to elicit information that covers interfaces 1-4 in Figure 1. Circular questions have the potential to cover all of the interfaces of the family and the illness, and to garner more assessment information, as well as move the family forward toward therapeutic goals.
    • Ask the parents/caregivers what it must feel like to be a child with a chronic illness
    • Ask the children what it must be like to have a chronically ill child
  • Identify phases of illness (Rolland, 1994) and what phase the family is in when presented for therapy (e.g., crisis, chronic, terminal). This has the potential to inform both the family and the clinician as to what might be expected for the family. For example, in the “chronic” phase it is not uncommon for the family to feel in a state of chaos and overwhelming emotionality (Rolland, 1994).
    • Ask the family how they knew or will know when they are moving to the next phase, after explaining to them what types of things typify each phase.
  • Draw Double ABCX Model on whiteboard and have family identify their stressors/strains, resources, perceptions, and coping mechanisms and pile-up. When the family responds to the following questions, also explore with them how the factors of the Double ABCX Model overlap with the Family Systems-Illness Model.
    • How have they dealt with these in the past?
    • How have previous family generations dealt with these same issues?
    • How might this model [the Double ABCX Model] correlate with the phases of the illness? For example, the “crisis” phase of the illness is likely to coincide with the pile-up of stressors/strains (aA factor).
  • Education and Psychoeducation
    • Help make clients aware of resources (e.g., HealthWave, community/local support groups, drug studies [free participation])
    • Educate the family about literature on the patient’s illness/condition
  • Strengthen ties between the family and health-care team (Rolland, 1994)
    • Have the family ask the physician questions about the illness, prognosis, etc. This has the potential to strengthen the family’s existing and new resources (bB factor), and then the family is better able to bolster their perceptions (cC factor). The family can thus use their resources and perceptions in the face of pile-up of stressors/strains (aA), which then leads to bonadpatation (i.e., good adaptation; xX factor).