Family Psychotherapy

Family therapy can play a pivotal role in sustaining, strengthening, and repairing family resources. The profound and enduring impact of the child's illness on the family is addressed within this context. Family therapy does not in any way preclude individual psychotherapy with the child; rather, it affirms the family unit as a whole and provides a framework for healing (Sourkes 1995). Family therapy is often provided in combination with individual psychotherapy to help open the lines of communication between children and their families about topics that parents are uncertain about how to approach. Most children who have lived with the cumulative toll of illness and treatment have acquired an accurate understanding of their life-threatened status or impending death long before others discuss it with them.

The protective stance of the past was that disclosure to children of their prognosis (and even, in some instances, the diagnosis) would cause increased anxiety and fear. Over the last two decades, however, a shift toward open communication has become more evident. To shield children from the truth may only heighten anxiety and cause them to feel isolated, lonely, and unsure of whom to trust (Sourkes 1995). Kreicbergs et al. (2004) found that bereaved parents who had discussed impending death with their children had no regrets about doing so; this was in sharp contrast to the regret felt by some parents who had avoided such openness.

Communication can be facilitated by the mental health clinician and may occur through a series of discussions that take place over a period of time (with the family's verbal and nonverbal cues guiding the pace) or by brief consultation to the family members so that they feel more capable of pursuing such discussions on their own. Considerations about what or how much to tell include the following: the child's age and cognitive and emotional maturity, and the family's structure and functioning, cultural background, and history of loss. These same factors apply at the end of life, with extreme sensitivity to how the parents have chosen to inform the child throughout the illness experience, how the child has understood and processed information up to this time, and what the child is now asking—both implicitly and explicitly—about his or her situation (Abrahm and Sourkes 2004; Sourkes 1995).

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