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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We used to never get enough…

43051d76d4b1990ed41.jpgWhere has the comedy gone? Relationships are falling flat and the adult world is taking over!!! The following is a review of Penny and Leonards System Dynamics. I would LOVE your feedback on the joy…or discontent… you find with these lovable friends!  (***ALERT*** longer post than usual but it’s worth dealing with the extra 3 minutes of reading! maybe.) P.s. I am sadly aware there are so many from this tribe I did not get to mention… mostly because this became SO LONG!

System Dynamics

Penny and Leonard Hofstadter’s family dynamics are challenging. They are a newly married couple living with a third party at all times. Discontent about a roommate with compulsive and controlling behaviors living with them named Sheldon Cooper was prevalent. Despite discussions, it ends with complaints without actions.  A newlywed couple in our society can view this as a negative impact on their time together.  Finally, Sheldon moves out and the couple then moves in another one of their friends, Raj, with his own personal interesting issues and challenges adding more tension.  There have been indicators prior to marriage that both parties do not believe they have another choice for a relationship and have settled for one another.

Boundaries are challenging within the Hofstadter couple’s marriage and are identified as permeable.  Both Sheldon’s and Raj’s issues bleed into Penny and Leonard’s relationship.  I believe most of the friend’s issues stay in the forefront in this household as people are continually coming and going.  This triangulation has become such a challenge, Sheldon even went on the honeymoon with the couple to San Francisco for what he convinced them was for personal reflection (International, 2015).
Leonard has mommy issues and low self-esteem, he seeks validation and affirmation from both Penny and his mother. Penny is a socialite, can appear selfish, shallow and is always looking to capture her dream as an actress. Penny seeks refuge in the wisdom of her one newly married friend (Bernadette) and one single friend (Sheldon’s Amy) to sort through marital challenges. TV-Show_the-big-bang-theory_270880.jpgThe couple has adopted Sheldon as a relationship akin to a younger sibling or a child.  They are unable to ignore him and move forward.  The more Leonard needs Penny, the more Sheldon needs Leonard. The couple presents with continual attempts to sabotage their own marriage, I believe both are in fear of losing the other and are finding themselves unable to face that fear. Pushing through fear is challenging and a way back to a healthy marriage is communication about these issues.

Sheldon has limited emotional recognition (maybe a sweet pea sized amygdala to blame) as well as lessened expressions of his own emotion.  He is controlling and orderly and many have described him as having Asperger’s syndrome and obsessive-compulsive disorder, but he insists his mother had him tested and he is definitively not classified as crazy.  Raj is not as overtly challenging as Sheldon, but his presence in the newlywed’s home still draws the focus away from whatever issues the couple may need to resolve.  If the issues remain on the back burner, they can fester and grow rather than create growth.

The couple’s supra-systems are impacted by social group differences and families of origins (Wetchler & Hecker, 2015).  Leonard’s personal devotion to all things science fiction is far removed from his wife’s yoga practicing, low-tech lifestyle choices. The families of origin come into play periodically abrasively reminding this couple of their vastly differing upbringing. Minimal history is provided of legitimate financial stability other than Leonard refusing marriage therapy due to the cost being a strain. Leonard comes from a high-achieving family and personally is an experimental physicist at Caltech with a sibling working as a tenured law professor at Harvard. Penny has a high school education or equivalent and a few college courses. There a is minimal family of origin history other than she has a sibling with drug addiction and a criminal record.

Penny and Leonard have a relationship agreement drawn up by Sheldon and agreed upon by the couple.  It consists of rules, roles, and expectations for their marriage. The covert rules are the challenges that create miscommunication, hurt feelings, and arguments between the couple after the issues have festered for period of time (Wetchler & Hecker, 2015).  I do not believe there has been at length communication about roles and expectations outside of this contract drawn up, signed, and amended when necessary.  This contract was developed due to Penny’s discontent over Leonard’s lack of romantic pursuit of her and her challenge to communicate her feelings with him.

Boy! Relationships can be messy!

For further reading on relationship agreements here is Sheldon’s and Amy’s for your viewing pleasure!

Penny: You guys just got back together. You might not want to ditch her on her birthday.

Leonard: I think Penny has a point. You can see it another day.

Sheldon: But someone might spoil the movie. No one can spoil Amy’s birthday for me. Surprise, she’s even older. Who saw that coming?

Penny: Aww, that’s nice. Put that on her cake.

References:

International, I. A. (2015). Retrieved June 26, 2017, from http://www.aamft.org/iMIS15/AAMFT/Content/About_AAMFT/Position_On_Couples.aspx

Wetchler, J. L. (2015). An introduction to marriage and family therapy. New York: Routledge.big-bang-theory-bazinga_114809.jpg

 

Take a Breath! 

Even when on a working vacation it’s important to practice positive self care! I’m not talking about taking a shower or using deodorant but we are all grateful when those things are consistent. 

Life is not what it’s supposed to be. It’s what it is. The way you cope with it is what makes the difference.

            -Virginia Satir 

I’m taking a moment to remind you and and mostly myself of one of the greatest lessons I am continually learning. To continue to move forward in anything self care must be a priority. Self care can wear many faces and people often label things as self care that are far from it. Let’s be real, authentic with ourselves and make time to exist and breathe and be okay. We get caught up in the depths of life’s current struggling to meet expectations of others but as Satie said… “We must not allow other people’s limited perceptions to define us.” 

What does that mean for you and your reality today? 

What are some activities or relaxation tools you enjoy in your own self care time? 

Theatre of the shoulds 

The theatre of the shoulds is an explanation for an experience many have when our head and heart must divide because the orthodoxy of Christian living doesn’t meet our needs as we live on earth and the structure of our community. This requires the theatre of the should outside and needs inside. Our hearts need to be quenched from a thirst far deeper than any earthly gift. We reach for anything that resembles “water”.  Our lives are divided into two parts… our secret life inside and the life others see. It’s a struggle. The alternative many choose is to simply deaden themselves if they do not seek out any water available.

What other option do we have? I am speaking of those who know Christ yet find themselves in this battle of numb it or drown it.

Despite aiming this at us ladies, I know this is a reality for both men and women alike…

I think a few answers are found in the word, worship, prayer, and community.  Reading the same chapters and books can become mundane at times but that’s when the spirit is able to bring revelation and we find His leading through prayer and community! It’s all connected!


What other ways have you found to keep yourself filled with joy and motivation? From where do you draw strength?

No Words

Who or what is dictating the story of our lives?  There are times in life we are left without any words to describe the internal experience of the forming of our story.  How do I feel?  Not how do I think or believe but how do I feel?  This is a challenging question because by and large many people tend to say “I feel…” when they are actually disclosing a thought or belief.  What is going on with me?  Would anyone actually understand?
bd140c955902c9dd708d7ed89cdf6462      I hear this from many clients and I have experienced it myself at times.  When we are left without words to express ourselves or find we are too fearful, isolation can surround our hearts.  An isolated heart can cause us to feel so far from those we love and the adventures we long for. What can we do?

When there are no words… Get creative! Don’t give your control to anything or anyone! Enough of life can be oppressive so stand your ground and own your journey however that may look! I would like to challenge even myself to fear not when I cannot describe and maybe reach out to the opportunity to express instead!  Often describing something that is felt versus thought can cause it to be flat and lifeless. Our feelings are far from flat and lifeless! We feel blue! We smell winter! We are as clean as a whistle! Our lives are more than our thoughts.  Such experiences more valuable in expression than description… how does blue feel and winter smell…

Let’s commit to being a believer of our realities and begin shaping circumstances into life experiences that create more of what we want.  Negativity can be found in all experiences but there’s a flip side as well… the positive outlook is a choice.  If we allow life, it will inhibit.  When will we be believers in our own ability to create better for ourselves?

I would love to hear of your experience with processing the world around you! Let’s stop and take a moment to become more self-aware. Just because we cannot describe whats happening inside doesn’t mean it doesn’t have validity or impact on our existence!

Bitterness or Betterness? It’s Up to Us.

I wholeheartedly believe it must be far better to forgive injustices of the past than to allow them to remain, let bitterness take root, and poison the rest of  our journey in life.  I can’t help but believe, in so many ways, bitterness is presently a common staple in our communities.  

I feel morally inclined to share a bit about how I rest in peace, not in a complete detailed break down maybe more of an overview.  I hope from this you readers will find motivation to seek peace in your own life if peace is not currently found.  

The photo of the Cliffs of Moher is a symbol of peace for me.  When my life is raging and fast paced, I do my best to reset the pace for peace by going to a happy peaceful place in my mind as part of that reset.  This is one of those memorable, impressive places I mentally revisit. When I was actually standing in the place I took the photo, I was surrounded by people but I could barely hear another voice beside my own.  The crowds of others were not standing directly beside me but one would have thought I could hear them at the short distances but I could not. Why? The winds where blowing so hard it drowned all other voices out but my own.  It was peaceful and serene. Despite the crowd I felt I was the only one standing on the cliffs surveying beautiful lands and waters. This was not a lonely alone but more like a conquering restful aloneness filled with all the peace I could fathom. This is a feeling I continually seek to replicate once I learned of its extent of restfulness for me. 

What will it take for us to set a pace of peace and be determined to live in the here and now and make efforts to create goodness around us? Instead we live in upset, disappointment, bitterness, and judgement… How will this help any situation? How can we hope for change and expect someone else to bring it? 

“There’s some good in this world, Mr. Frodo……..and it’s worth fighting for!”  -Samwise Gamgee

Love- by Sara Groves helps tell the story of what I am attempting to convey. Enjoy.