The Family Problem Intervention

Published Date: 02 Nov 2017

Illness and families

The entire family system is affected when an individual is afflicted with serious illness or disability, which disrupts the entire household. Rosen and Kimmey (1971) conveyed that it is not only the individual, but also the family who is introduced to the health care experience. There is a need for education and counseling for both the individual and their family, as each member plays a role in everyday family functioning. Kozlowska, English, Savage, and Chudleigh (2012) argued that illness in families can result in high levels of resource depletion and imposes long-standing responsibilities of care on families. .

The Nature of the Problem

Illness of one family member changes the lifestyle of the entire family. For example, a family member may be burdened by assuming some of the functions of the ill person, which in turn affects their own normal routine (Kozlowska, English, Savage, & Chudleigh, 2012). Additionally, an adolescent taking care of a single parent might be awake much of the night; the lack of sleep could contribute to poor school attendance and grades. In contrast, a middle-aged adult with older children may be burdened with a need to accommodate care needs of aging parents, which could pose a financial burden if it interferes with their retirement plans (Rosen & Kimmey, 1971).

In addition, having a sick family member can cause economic problems for the family, and disrupt the developmental progress of other family members (Kozlowska, English, Savage, & Chudleigh, 2012). Illness can cause chaos. For example, siblings may not get their needs met because their mother is focusing much of her energy an ill child (Rosen & Kimmey, 1971).

Factors, such as the family’s level of functioning prior to illness, socioeconomic status, the severity of the illness, and the ability of other members being able to assume responsibilities of the sick family member, can all affect the extent of family disruption (Rosen & Kimmey, 1971). In some instances, a major illness can bring a family closer together; while in others, even a minor illness can cause significant problems. It is important to identify what the illness means, not only for the individual who is ill, but also to the family. Therefore, it is important for the therapist to assess the family and determine the impact of the illness (e.g. potential changes or outcomes) on the family and the individual (Kozlowska, English, Savage, & Chudleigh, 2012).

The family needs to be made part of the treatment plan. It is an important to encourage family involvement, as members can be used as a source of support for the client as they work through their treatment goals (Kozlowska, English, Savage, & Chudleigh, 2012). For example, it would be difficult for a parent to be supportive of their grown child if they did not understand the reasons for the recommendations and the consequences of not following through.

Kozlowska, English, Savage, and Chudleigh (2012) argued that illness makes adjustment difficult in family relationships, even in the most stable and supportive families. Therapists need to identify patterns of relationships and to be aware of attitudes of family members, especially in relation to the illness. Rosen and Kimmey (1971) reported that illness in a family member tends to raise the anxiety of those close to that person; however, anxiety can be expressed negatively by lack of interest or as reluctance to provide help and support. It is important for a therapist to be aware of these reactions and help family members process their feelings about the client’s illness and treatment.

Healthy Attributes in Family

Families can have healthy attributes, such as optimism, that can ease some of the negative impact of an illness. Black and Lobo (2008) identified family resilience as a successful coping of family members under adversity, such as illness, that encourages warmth, support, and cohesion. Family research has suggested that other factors, such as a family’s faith, positive relationships within the family, adaptability, open communication, financial support, time spent together, routines and rituals, and other supportive systems help determine resiliency in families (Black & Lobo, 2008, p. 53). A treatment model that uses a family resiliency acknowledges inherent strengths and the potential for growth in families. Additionally, it provides the therapist with an opportunity to facilitate family protective and recovery factors and to secure outside resources to help foster resilience.

Walsh (2011) argued that using family resilience as a metaframework can be a strength-based practice approach as it includes several advantages. For example, resilience focuses on strengths when confronted by stressful situations and adversity. A family resilience framework helps identify and facilitate family process and is highly adaptable in its application regardless of any challenge or adversity the family is facing. The resiliency framework can help identify interventions and prevention efforts on key processes. It is flexible in relation to diverse family values, structures and resources (Walsh, 2011, p. 51). Families that demonstrate high resilience have the potential for mastering life’s adversities, but also become more resourceful in facing future problems and challenges, as they learn to use their strengths as a tool in recovery.

Intervention: The Systemic Model

Walsh (2011) identified a model that includes psychoeducational, assessment, and intervention in treating families facing illness. The model addresses the systemic interaction between illness and the family, the type of illness, the major phases in the family’s history, and key family variables. Therapists need to evaluate and assess the family and client’s life cycle, such as the course of the illness; multigenerational issues related to loss and illness; and belief systems. For example, a client with cancer needs to be assessed regarding the type/severity of cancer, treatment options available, family history of cancer and death, and spiritual beliefs regarding death.

Determining the psychosocial demands of an illness affecting an individual is an important factor for a therapist working with a client. The onset, course, potential outcomes, and the extent of incapacitation of the illness need to be identified when creating an intervention plan. Depending on the illness, there will be various demands and tasks that will require the family to use different strengths and attitudes (Walsh, 2011, p. 465). For example, a child might have to overcome fears of body fluids or needles in order to care for a parent with diabetes or a colostomy bag.

Hughes (2008) argued that interventions should focus on supporting the family and the ill client, directly reducing the family’s distress caused by the illness and the overall impact on their health and well-being. In addition, interventions need to help make the family as a whole become more competent and confident and provide safe and effective care to the ill client, which can indirectly reduce stress on the family system (Hughes, 2008). For example, teaching relaxation techniques to family members, initiating regular family meetings to delegate care tasks, and providing respite could be helpful in reducing stress.

It is important to teach family caregivers how to manage specific problems they may encounter with their ill family member in order to improve the well-being of all in the family. For example, not having time to properly care for one’s diet needs can cause impact a caregiver’s personal health and induce fatigue and exhaustion, which can have an adverse effect on both the physical and emotional health of the caregiver (Hughes, 2008).

Emotional counseling is just one aspect of treating illness in families. A therapist should also teach a family healthy life skills including the importance of eating healthy, having regular sleep habits, as well as, giving them information regarding end-of-life care when an illness is terminal. Other skill and coping training interventions that can be used with a family include skill building, home visits, problem-solving, and education about the illness and practicing resiliency skills. In addition, case management interventions, such as assessing, planning, implementation, coordination and monitoring, and evaluation of options can be included. Extensive care, including medication and symptom management, caregiver and family supportive counseling (Hughes, 2008) can also be used. Walsh (2011) argued that clinicians need to explore the level of agreement and tolerance for differences among the family members’ beliefs and their relationships with the health care system. The interventions used need to take into consideration the attitudes of the family’s ability to influence the course and outcome of the illness.

Future Outcomes

It is difficult to predict the outcome of these intervention processes, as they carry many strengths and limitations. However, families can gain experiences that teach them skills that will improve their overall quality of life. The therapy can aid in achieving a healthy balance between tolerating boundaries and encouraging autonomy. Interventions can strengthen a family by enhancing their ability to cope with loss, maintain hope, adjust goals, build rituals, and encourage flexibility in future planning. Limitations, however, can include a clinician’s own bias and experience with illness and loss. Understanding one's history with dealing with illness and health beliefs can help the therapist to work effectively with clients and families who are challenged by illness.