A waiting-room handout can also be helpful for families of patients with chronic illness. Because their ability to provide consistent illness management is crucial for the patient’s optimal outcome, we encourage family members to keep the following goals of therapy in mind:
• To help families cope with and manage the continuing stresses inherent in chronic disease management as a team, rather than as individuals.
• To mobilize the patient’s natural support system, to enhance family closeness, to increase mutually supportive interactions among family members, and to build additional extrafamilial support with the goal of improving disease management and the health and well-being of patients and all family members.
• To minimize intrafamilial hostility and criticism, and to reduce the adverse effects of external stress and disease-related trauma on family life.
Family members of the chronically medically ill usually are receptive to meeting with a psychiatrist. Often, the patient is depressed, anxious, or struggling to cope, and the requests of the spouse to get help are frequently dismissed. Patients feel that if their medical condition gets better, they will feel better. All their effort is focused on finding the "right doctor or the right treatment" for their medical problems. Understandably, patients do not want to accept that they have a chronic illness, and they resist thinking about making adjustments to their lives.
Ms. Palermo, however, did seem receptive to change. "So I am not crazy?" she asked. "So there is hope for me?"
"Let’s work on this together," Mr. Palermo said. "We can still enjoy life, even if we can’t do the things we used to do."
I scheduled a further appointment with them to review their relational functioning in more depth, and to clarify their individual and dyadic coping skills. If they are interested, we will work together on the difficulties that they identify. A family systems intervention can be short, focused, and completed in 6-8 sessions.
Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She has been a member of the Association of Family Psychiatrists since 2002 and currently serves as the organization’s treasurer. In addition, she is the coauthor of two books on working with families and is the author of numerous articles on this topic.