Categories
Psychology

Marriage and Family Therapy with Chronic Illness

Introduction

Chronic illness not only affects the patient but also the immediate family members especially a partner in a relationship. Furthermore, treatment of chronic illnesses goes beyond medicine because the client and the family members must be assisted in coping with the psychological and physical needs of the disease. A client’s need for emotional support, the symptoms of the disease and the physical assistance they require exert an emotional toll on close family members (Draper & Dallos, 2005).

Research has also indicated that close family members have a significant impact on the psychological adjustment of the client to the condition, which include following treatment regimens and incorporation of other health behaviors that enhance functioning and recovery from the illness. The close connection between a client’s chronic illness and family relationships has forced researchers to develop and change client-centered psychosocial interventions to incorporate close family members, especially the spouse of the client. One of the interventions that have been developed is to aid the client and close family members cope with the various demands of a chronic illness. Other psychosocial interventions have been developed to focus on the family member whom the client depends on for psychological support and physical support (Shields et al, 2012). These interventions are Marriage and Family Therapies (MFT) because they focus on the client’s close family members by either involving the client or not.

Benefits of involving family members

Broad correlation research studies have highlighted the significance of involving close family members in the management of chronic illnesses via psychosocial and behavioral interventions. Several family related factors such as excessive protection, criticism, attentive attitudes, emotional support, conflict, and intimacy have been shown to be closed connected to various client physical and psychological outcomes such as physical disability, psychological well-being, pain severity, and health behaviors (Carter & Carter, 1994). These outcomes have been recorded in various chronic diseases such as cancer, rheumatic disease, and heart diseases. These studies were mainly centered on the client’s spouse because a spouse is the closest person to a client with the opportunities to influence the client’s health through physical and emotional support, and interpersonal conflict.

Further research has revealed that a client’s close family members may experience lowered relationship quality with client, poor physical health, more care giving burden and deprived mental comfort (Blazquez & Alegre, 2013). These outcomes have been observed in different client-family populations and in families with older members with several health impairments caused by chronic diseases. The severity of a client’s illness is closely linked to strain in family relations and deprived family member health. Carter & Carter (1994) point out that chronic illness that cause cognitive impairment have been shown to cause more strain to family members. Considering the manifold relationship between client and family member outcomes, psychosocial interventions that incorporate a client’s close family members can lead to more benefits compare to interventions that focus on the client alone or medical interventions in enhancing the client’s physical and mental health (Shields et al, 2012).

Meta-analytic reviews of the effectiveness of family centered interventions have shown that involvement of close family members in managing chronic illnesses have positive health outcomes.  The key aim of these reviews was to determine the extent of effectiveness of psychosocial interventions incorporating family members. Some chronic illnesses require assistance from close family members in doing daily activities and supervision such as stroke and dementia (Draper & Dallos, 2005). Others are fatal such as cancer, while some are associated with severe pain such as arthritis and chronic pain. Heart  disease are also a category of illnesses that family focused interventions have a positive impact because they demand a change in lifestyle, and family members can exert  substantial effect on lifestyle change. Outcomes of further meta-analytic reviews have also shown that family centered interventions that incorporate the spouse lower a client’s depressive symptoms. This outcome can be attributed to the tendency of the spouse being less critical and supportive of the client. It is also possible that the client as a form of support considers the incorporation of the spouse. For chronic illnesses such as heart conditions, family centered interventions are effective in behavioral change such as enhanced dieting and exercising, and broad supervision concerning health (Martire et al, 2004).

Review of Randomized Clinical Trials (RCTs) of family centered interventions

The review of these interventions concerns interventions that help family members learn home-based care giving roles, enhance family partnership for disease management, and improve planned cooperation with healthcare providers. These interventions are psycho educational in nature because they incorporate skills training, support, and education.

Neurological illnesses

The most common neurological disease that exert physical and emotional burden on close family members are stroke, Traumatic Brain Injury (TBI), and epilepsy. TBI irreversibly changes life and close family members especially spouses take over almost all parenting roles and become the main caregivers. Isolation of the family may result due to embarrassment caused by a client’s behavior. Several studies have shown that family centered interventions can be beneficial to both the client and family members (Martire et al, 2004). Family members who receive problem solving training have reported decrease in depressive signs, dysfunctional problem-solving methods, and complaints (Martire et al, 2004). For parents caring for children aged between 5 and 16 years suffering from TBI, online family problem-solving therapy has shown decreased depression, parental anxiety, and distress after pediatric TBI. These studies support the view that involvement of family members benefits the client and enhances the functioning of caregivers.

Family members and caregivers of clients suffering from stroke experience elevated depression, increased burden and lowered life satisfaction during the cause of disease and chronic care. Studies have shown that family support during recovery from stroke is linked with improved functional and psychosocial results for clients (Blazquez & Alegre, 2013).

Clients suffering from spinal cord injuries report acute and chronic pain, feelings of pain from senses that do not primarily cause pain, and musculoskeletal pain. Close family members who are the primary caregivers experience depression, burn out, fatigue, anger, and bitterness and stress (Bradford, 1997). Several RCTs have shown that family centered interventions for clients suffering from spinal cord injuries have beneficial effects on both the client and caregiver. An intervention such as videoconferencing PST given over a period of twelve month has shown to lower depression of care givers and increased functioning of the client.  Face-to-face PST interventions have reported lowered impulsivity and avoidance among caregivers in response to stress.

Cardiovascular Diseases (CVDs)

Although studies on the effectiveness of family interventions on CVD are still at their developmental stages, interventions given by a health psychologist aiming at altering client and spouse views of CVD compared with normal hospital-based care succeeded in showing more optimistic disease perceptions and less concerns regarding the client’s recovery in partners (Martire et al, 2004). Other studies have shown that patients suffering from CVDs report poor adjustment if their spouses show elevated anxiety and depression (Blazquez & Alegre, 2013).

Cancer

Cancer is perhaps one on the chronic illness with adverse physical and psychological effects on both the client and family members. The uncertainty associated with cancer illnesses, side effects of medications and worsened physical conditions are some of the challenges that clients, family members and caregivers must cope with. A nurse-led intervention for couples adjusting with breast and prostate cancer showed lowered negativity, enhanced communication among the partners, decreased uncertainty, and limited hopelessness (Martire et al, 2004). In addition, other studies have shown positive outcome for both the client and spouse when they are both involved in the treatment intervention. Women suffering from breast and gynecological cancers who were given coping interventions with their spouses showed enhanced positive interactions, decrease in psychological stress and avoidance, and increased sexual self-esteem compared with those who received interventions alone. For couples who received interventions together for mastectomies, they reported decreased depression, more relationship satisfaction, and positive self-image, and enhanced frequency of initiating sex and realization of orgasm. Women who received treatment interventions with their husbands suffering from prostate cancer reported decreased denial of their husband’s condition than those who did not receive intervention treatments with their husbands (Martire et al, 2004).

Family centered interventions are also effective in family hospice and bereavement interventions in end of life care. Care givers, whether they are family members or not experience elevated levels of distress, while patient may experience elevated levels of pain. Studies have shown that an in-home intervention coupled with hospice care is more effective in helping clients manage pain and symptoms, and increased self-efficacy of caregivers than hospice care alone (Martire et al, 2004). Interventions involving spouses and family members at the end of life helps families manage stress that comes with death. Others studies have shown that involving parents with children suffering from cancer by providing Coping Skills Training (CST) is effective in lowering post traumatic stress signs and anxiety (Bradford, 1997), which in turn help them in providing care to their children effectively.

Diabetes

Diabetes is a chronic disease that demands observance to a daily treatment schedule that involves measurement of blood sugar levels, exercise, administration of insulin and recommended dieting. Complications that result from poor observance of treatment regimen include heart problems, kidney failure, amputation, blindness, nerve damage, or death. Children suffering from diabetes require help in managing this disease than adults, and this remains a public health issue. Two family-based interventions are suited for the management of diabetes. Multisystem Therapy (MST) is founded on cognitive behavior therapies, structural family therapy and behavioral parent training, and research studies have shown that MST is effective in improving treatment observance and in lowering the number of emergency room visits (Martire et al, 2004). Family relationships and the monitoring of glucose levels determine diabetes outcomes.

Behavioral Family Systems Therapy for families with client suffering from Diabetes (BFST-D) given in twelve sessions over period of six months coupled with family functional therapy, communication training and cognitive restructuring have shown decreases in conflicts that are related to diabetes and improved glucose control compared with Education Support (ES). Other studies have shown that Team Work intervention (TW) that involves parents and youth suffering from diabetes in roles such as sharing disease tasks, solving challenges such as glucose control, and communicating effectively is effective in ensuring stable glucose control, decreased family conflicts, and enhanced family cohesion (Bradford, 1997).

Treatment using systemic therapy

According to Draper & Dallos (2005), there is need for the integration of family therapy with the larger healthcare system in order to help clients and their family members cope with chronic illnesses. This is followed by developing a clear theoretical framework on the power of family on health performance. Choosing the appropriate intervention that target specific behaviors that enhance health functioning is the next step. This is because different chronic illnesses have different medical needs and health behaviors. If a patient is suffering from an illness such as diabetes, a therapist must target those family processes that enhance medical conformity and heath behaviors associated with diabetes. In the case of distressed caregivers, therapist should focus on social support to lower social isolation, coping skills to enhance management of stress, or therapy skills for enhanced functioning of the client. Therapist must know that each medical condition or client symptom may have various precursors that serve as objectives for intervention. It is the responsibility of the therapist to develop a suitable theory of the predicament. This will enhance the selection of the the intervention approaches that have exhibited some guarantee in managing the disease symptom (Draper & Dallos, 2005).

Conclusion

Helping families adjust to the demands of a chronic illness is one of the therapeutic objectives of MFT. This is explained by the role that immediate family members, especially spouses play in coping and adjusting to a chronic illness. It is clear from existing literature that there is great potential for family focused interventions to lower client and caregiver distress. This also enhances the client health functions through observance of treatment regimens as well as to strengthen spousal cum family relationships. Future research on MFT must show changes in client’s medical outcomes in order to be relevant to the budding healthcare setting.

References

Blazquez, A. & Alegre, J. (2013).Family and Partner Facing a Chronic Disease: Chronic Fatigue Syndrome. The American Journal of Family Therapy, Vol, 41, 46–62.

Bradford, R. (1997). Children, Families, and Chronic Disease: Psychological Models and Methods of Care. London: Routledge

Carter, E.R. & Carter, C.A. (1994): Marital adjustment and effects of illness in married pairs with one or both spouses chronically ill, The American Journal of Family Therapy, 22:4, 315-326

Draper, R. & Dallos, R. (2005). An Introduction to Family Therapy: Systemic Theory and Practice, 2nd edition. New York: Open University Press

Martire, L.M et al. (2004). Is It Beneficial to Involve a Family Member? A Meta-Analysis of Psychosocial Interventions for Chronic Illness. Health Psychology, Vol. 23, No. 6, 599–611.

Shields,C.G et al. (2012). Couple and family interventions in health problems. Journal of Marital and Family Therapy, Vol. 38, No. 1, 265–280