The Effects of Chronic Illness on a Family System

A Current Issue and the Effect on a Couple

“Research shows that couple dynamics influence the immune, endocrine, and cardiovascular systems, and self-reported health status; and medical problems can affect all areas of a couple’s functioning, including communication, sexual and emotional intimacy, and role flexibility (Dankoski & Pais, 2007).” Using therapeutic services may be helpful for a family to process a new way of living or a loss of the previous lifestyle due to the course of a chronic illness.  Family therapy can provide the system with tools and support to manage the anxiety, depressions, fear, miscommunication, potential conflict, and stressors brought on by the needed adjustments and caregiving accompanying chronic illness.

 When a couple faces chronic illness

 Facing a chronic illness such as an autoimmune disease can take years of searching and testing for a diagnosis. Once the family receives the diagnosis there are mixed emotions that accompany such as both fear and relief.  Relief comes due to finally knowing the name of what the family is fighting and the protocol that may come with that specific disease. Fear and distress floods a family as they see potential and sometimes probably declination in the future of their loved one’s quality of life and the challenges the family will be facing for a lifetime.  The diagnosis of the illness marshals in the opportunity and need for further family and loved one’s support systems to increase the resources, readiness, and availability.

One of the major tasks a couple has to face is first learning about the illness and what they will be facing, their options for treatment and quality of life, as well as available resources concerning their specific challenge (Dankoski & Pais, 2007). Living with chronic illness can be isolating and cause depression and anxiety.  Activities the couple once enjoyed may no longer be an option due to the limitations of the illness and this may cause friends and social supports to move on in life and in a sense, leave the couple behind if the illness prevents the couple from participating often in social gatherings.  Adjustments and accommodations can be made if the couple and their social supports are willing to work together for the sake of the value of the relationships.

Impact on relationship

The chronic symptoms of an autoimmune disease can be perceived as burdensome by caregivers or support system members, or the fear of being a burden can be overwhelming by the ill individual.  A couple faces great strains on traditional couple activities, socializing, physical intimacy, time, and life/marital milestones.  Confusion and misunderstandings can occur as each person is struggling to process the changes needed in their lifestyle.  Frustration can arise from multiple doctors and years of misdiagnosis and worsen symptoms without answers until diagnosis finally occurs. Depression and hopeless can plague the couple due to loss and perceived future losses. Chronic illness can create deep feelings of hopelessness for a happy marriage or happy life, but it doesn’t have to be that way.  Feelings of anger and discouragement may be encountered as the learning phase is navigated for this lifelong adjustment that will more than likely continue to change and morph, but the key is to monitor and adjust and rely on not only each other but social and familial supports (Law &Crane, 2003).  If the couple does not reach outside themselves for support and help for care, there is a possibility for the destruction of the family system; but with utilizing the resources available, support systems and education, strength and encouragement, hope and positive outlooks can be found.

 Goals of therapy

Approaching this situation as both an individual with a rare chronic illness and a clinician, I see ample opportunity for solution-focused brief therapy with components of narrative therapy to be effective in helping the couple create the desired changes and set the appropriate goals they believe they are able to work toward. Psychoeducation is an important facet of the therapeutic process the provide the couple with needed information about resources, stages of grief and the value of understanding why goal setting and commitment are paramount for success (Law &Crane, 2003). A component of narrative therapy that will be helpful for a couple in this situation is restorying.  Changing the way the couple perceive the situation and their role in this new adjusted way of living will require the clinician to assist them in re-authoring their story in a positive light typically contrary to natural reflex; then assist the couple in creating the alternative more preferred story that is less problem-saturated but seeks out exceptions, positive perspectives and ways to make the most of the positive available (Law &Crane, 2003).

Solution-focused therapy will also provide effective care for this specific type of challenge a couple will face. Looking for exceptions, using scaling questions to help them become more self-aware and finding ways to help them take baby steps toward lowering the depression level to one level lower at a time. Asking the couple how they would know depression had changed from a seven to a six on a scale of one to ten. Scaling questions, psychoeducation, and exception identifying are effective tools; but I would further the work by having the couple set short-term measurable goals they are able to work toward and commit to establishing to the possibility of victories given the right motivation and partnership of support within the couple and family.

Reference for further reading! 

Spoon Theory If you haven’t read this and you love someone chronically ill….

American Association of Marriage and Family Therapy. (July, 2016). Chronic
illness. 
Retrievedfrom http://www.aamft.org/iMIS15/AAMFT/Content/Consumer_Updates/Women_and_AutoimmuneDiseases.aspx

 Dankoski, M. E., & Pais, S. (2007). Whats Love Got to Do with It? Journal of Couple & Relationship Therapy,6(1-2), 31-43. doi:10.1300/j398v06n01_04

Law, D. D., Crane, D. R., & Berge, J. M. (2003). The Influence Of Individual, Marital, And Family Therapy On High Utilizers Of Health Care. Journal of Marital and Family Therapy,29(3), 353-363. doi:10.1111/j.1752-0606.2003.tb01212.x

Thomlison, B. (2016). Family assessment handbook: An introduction (4th ed.). Boston, MA: Cengage Learning. 

Wetchler, J. L., & Hecker, L. L., & (Eds.). (2015). An introduction to marriage and family therapy. (2nd ed.). New York, NY: Routledge Taylor & Francis Group.

 

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