Using systemic family therapy to manage illness

Leading consultant psychologist Dr Cristina Lopez-Chertrudi provides an in-depth assessment of using systemic family therapy to manage illness, offering several case studies to exemplify its use in modern healthcare.

How does chronic illness affect a wider audience, not just the individual?

The impact of chronic illness extends beyond the individual, affecting familial, socio-economic, and employment dynamics, as well as healthcare systems. There's a shift in socio-cultural values towards increased illness attribution, weakened medical authority, strengthened patient rights, and heightened media influence. As someone working with chronic illness, my role involves enabling individuals to acknowledge, accept, and adapt to the persistent challenges of their condition, including drastic changes in family life, lifestyle, and well-being. I aim to foster self-confidence and promote exploration of personal experiences, facilitating a shift from individual to universal understanding.

In a clinical setting, I encountered cases illustrating the importance of contextual factors and socio-economic influences on treatment outcomes. Sonya and her husband, Mike, sought consultation due to Sonya's declining mood and functioning after experiencing multiple losses, including her job, health, lifestyle, and familial roles due to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Financial difficulties compounded their stress, exacerbated by the trauma of losing one of their daughters to a chronic condition earlier in their 30-year marriage. Sonya's coping mechanism of keeping busy to manage grief was disrupted by the onset of CFS/ME, altering their relationship dynamics. Sonya's childhood trauma, compounded by an unrepaired attachment with her mother, left her with a fragile self-concept.

Their youngest daughter's struggles with obesity and self-harm added to their concerns, especially as she declined therapy. Sonya's illness consumed her parenting role, while Mike's presence diminished as he took on caregiving responsibilities. They were navigating the process of applying for ill health retirement, facing a dilemma between pursuing rehabilitation and reinforcing illness through financial settlements.

The uncertainty surrounding their financial security perpetuated symptoms and compromised treatment effectiveness. Therapeutic progress risked jeopardising disability status, highlighting the complex interplay between health improvement and social welfare systems. Recognising the impact of socio-economic factors on therapy engagement, the therapist facilitated collaboration with the CFS/ME team and psychiatrist overseeing Sonya's retirement application.

Both the couple and the therapy team acknowledged the detrimental influence of employment and financial stressors on their ability to participate fully in therapy. They opted to continue sessions once the retirement process concluded. Mike found solace in witnessing Sonya's emotional journey and recognised his own need to grieve their daughter's death.

The therapists emphasised the importance of exploring socio-economic and occupational aspects of family life to identify barriers to recovery. They advocated for changes in the benefits system and employment laws to prevent perpetuating the effects of long-term disability, emphasising the need for holistic support beyond medical intervention.

Brian and Angie sought help to strengthen their relationship, which was impacted by Brian's long-standing struggle with chronic fatigue syndrome/myalgic Encephalomyelitis (CFS/ME). Brian faced misdiagnosis and endured stigma and neglect from medical professionals and social circles, while Angie struggled with his intense emotions and self-destructive tendencies. Therapy explored their communication patterns, coping strategies, and beliefs about CFS/ME within their social and cultural context. They recognized their relationship as a journey of challenging familial norms and seeking spiritual growth.

The therapist reflected on the influence of Western medical traditions on understanding illnesses like CFS/ME, cautioning against assuming psychogenesis and emphasising the need for holistic care to avoid misdiagnosis and unnecessary distress. Patients' reluctance to discuss emotional issues may stem from fear of stigma. In complex cases like Brian's, a collaborative approach integrating psychological and medical care is essential, focusing on individual presentations rather than just diagnostic labels. Therapeutic recommendations should align with a family-focused, psychologically-based approach integrated into medical treatment.

Joanna's experience with chronic fatigue syndrome (CFS/ME) exemplifies the hidden struggles of chronic illness and its profound impact on life stages. Affected since her teens, Joanna's condition thwarted her transition to adulthood, leaving her reliant on her parents and isolated from external relationships. Her family, feeling responsible for her struggles, exhibited distress and uncertainty about her future. Drawing from resilience models, the therapeutic team helped Joanna and her parents tap into coping resources, envisioning a path towards Joanna's return to medical training and her parents' eventual retirement.

This narrative underscores the transformative potential of illness on relationships, highlighting the need for healthcare professionals to embrace diverse perspectives and approaches. In the face of economic pressures and professional challenges, there's a call for healthcare providers to offer comprehensive psychological and spiritual care and reflect on a ‘call to consciousness’ and the deeper meanings of life.

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