Family therapy and terminal illness

Abstract

This article describes the experience of a family therapist working in a family with an adolescent child suffering from a terminal illness. This work was undertaken in the framework of the Mexican Institute of Social Security.

In dealing with patents afflicted with incurable diseases such as renal deficiency, osteosarcoma or leukemia, which will eventally lead to death, it is important to know about the successive stages in this progression from life to death and to understand them. Some authors have studied in general the reactions of the dying and their families. Kubler-Ross (1970) reports denial, resentment, bargaining, depression and acceptance; Eric Lindemann (1944) mentions pain, anxiety, tension and guilt as the main components of mourning.

Psychotherapy with the terminal patient and their family is intimately concerned with the separation process, which is always accompanied by anxiety; this can become so acute that it feels like death or total annihilation. The family responds in many ways to this anxiety, but will often not express these feelings; the therapist has to try to discover at which stage of mourning the family has arrived. This is even more important where the patient is an adolescent who has no hope of achieving his longing to live. It is important that we are dealing here with anticipatory mourning, which can prevent serious reactions following bereavement. Great care is required in uncovering feelings of hostility, anger, fear, repulsion and frustration. The patient too must be encouraged to express his feelings; this will relieve tension, and make it easier for the family to accept the reality of what is going to happen.

It is important to keep the family informed about the medical requirements of the treatment. These should be explained very clearly, so that all members understand, accept and cooperate in such tasks as ensuring attendance at out-patient consultations, laboratory investigations and taking the medicine prescribed. We find that often only one member of the family, usually the mother, carries the whole responsibility of caring for the patient. All these matters need to be discussed with the whole family, together with such matters as the patient's school attendance, any problems of family relationships, and plans for the future. The worker needs to help family members to continue their personal growth and development while understanding this crisis, which might otherwise arrest them.

Treatment should not be rigidly planned at the start; as in all psychotherapies, it is necessary to make an initial evaluation of the degree of function and dysfunction in the family. This appraisal is made by exploring family problems, areas of conflict and the resources which are mobilized to support the system. In this process the worker collects all the elements which enable him to get a picture, free from his own technical preferences, so that the data can be integrated, taking into account the opinions of experts on structural family therapy, triaxial or psychodynamic views among others.

In the case I shall describe, we used a combination of theories and techniques, mainly derived from systems theory and psychoanalysis. A purist attitude was not adopted, because our main aim was to find what was of most immediate benefit to patient and family.