Chronic illness has a profound effect on family functioning. Families undergo major changes when a family member has a chronic medical illness. The whole family may need to reorganize and life goals commonly change. For most chronic illnesses, the family's ability to provide consistent illness management is crucial for an optimal outcome.
Example of Family Intervention
The following example helps illustrate how family interventions can be helpful for illness management.
Mr. Jones came to National Jewish Health for assessment of his breathing difficulties. He and his wife reluctantly agreed to attend an assessment with a mental health professional.
Jones: Why am I seeing a psychiatrist?
Psychiatrist: Thirty-seven percent of people with chronic obstructive lung disease (COPD) have anxiety and panic disorder and 42 percent have depression. Fifty percent of people with asthma have depression and 25 percent of people with asthma have panic disorder. Some people cope well with chronic illness and others find it difficult to make changes in their life style.
Jones: Yes, it is hard to cope. I can't do all the things I used to do. I can't go for hikes, walks, or cycle. I just sit in the house now.
Mrs Jones nodded and looked anxiously at her husband.
Psychiatrist: What about difficulties with sleep, appetite, energy and concentration?
Mr. Jones went on to describe poor sleep, low energy and difficulty getting interested and concentrating on anything. His wife agrees that he has become withdrawn and smiles less. She has tried to get him to help her redecorate the house, but he says he is not well enough.
The psychiatrist continued the interview, asking about previous life experiences and ways of coping. When Mr. Jones was at college, he had some depressive symptoms related to challenging classes and low marks. He coped at that time by taking extra classes and hiring a tutor to help with exam taking strategies. The psychiatrist explained that coping with chronic illness also may require that he develop new strategies and that perhaps he could include his wife as a 'tutor' to help him.
Mrs. Jones was enthusiastic about this and the rest of the session focused on life style changes that they could make together. Towards the end of the session, antidepressant medication was discussed and their possible role in helping with sleep, energy and concentration. Mr. and Mrs. Jones wanted to try the new strategies first but took away handouts describing the role of antidepressant medication and agreed to discuss this when they returned to the clinic in two weeks.
This session shows that involving the patient's spouse can be helpful in the development of a program of disease management in ways that are consistent with the patient's beliefs and life-style. Involving Mrs. Jones also mobilizes the patient's natural support system.
The next session focused more on Mrs. Jones and her need to continue with her job and commitment to her children's after school activities. They were able to discuss a compromise in roles with Mr. Jones taking on some of the responsibilities with the children in the evening as he was no longer able to work full time. Mr. Jones was also able to talk about his feelings of loss regarding his work and role as the major income provider in the home.
This session helped all family members by preventing the disease from dominating family life and sacrificing normal family developmental goals. Mr. Jones also began to deal with the losses that chronic illness can create.
The third session focused on Mr. Jones continued difficulties with sleep and energy and he asked about starting medication. Mrs. Jones agreed and stated that they had discussed it together and read up on it. Citalopram 10mgs was prescribed once in the morning.
Benefits and Goals of Family Interventions
Mr. and Mrs. Jones reluctantly came to their appointment with the psychiatrist. After one meeting, they understood that dealing with chronic illness is a source of stress for most people and that there are ways of managing stress that will improve their quality of life. Sometimes patients will want medication to help with specific symptoms but other times, patients will want to implement only lifestyle changes. Generally, psychiatrists focus on educating patients and their family members about depression, anxiety and coping with chronic illness. Psychiatrists aim to guide each patient and their family to choose the best solution for their situation.