Siblings

A focus on the well siblings is an important aspect of the family work. Too often, the siblings stand outside the spotlight of attention, even though they have lived through the illness experience with the same intensity as the child and parents (Sourkes 1987). Healthy siblings experience many of the same issues as the ill child: loss of control and predictability over their schedules, loss of a personal identity (e.g., being identified as the sibling of a dying child), and loss of interpersonal relationships (because of changes in routine that exclude them from their normal social opportunities) (McSherry et al. 2007). The healthy siblings share common questions and concerns; they raise some with parents, professionals, or another trusted adult, but they harbor others silently.

Typical sibling concerns may include the fear of becoming ill, guilt about escaping the disease, and anxiety resulting from a lack of information or misinformation (Sourkes 1987). Rarely mentioned but often present is the unacceptable feeling of shame at having a "different" family, marked by an ill sibling who is disfigured or dying. Siblings may harbor anger around diminished attention and nurturance from their parents, especially when the ill child is in the hospital. Siblings who themselves are feeling deprived may also resent stepping in as surrogate parents for younger brothers and sisters. Once the ill child is home, siblings may resent the extra attention and privileges accorded to him or her, shifting their complaint from that of "too little attention" to "preferential treatment." Parents, meanwhile, often struggle to maintain equality and normality when, in fact, a distinctly "abnormal" factor in the family constellation exists. Another common issue is that of siblings' anger at parents for not having been able to protect the patient or even their perception that the parents (by commission or omission) played a role in the cause of the illness.

Siblings' academic performance may be impaired because of their preoccupation, or they may focus on school to ensure a sense of competence in the face of stress and helplessness. Similarly, siblings may curtail contact with their peers in their need for a family focus, or they may turn increasingly to their friends for support or to flee the pain at home. Physical symptoms and sleep problems are commonly found within a sibling group. They may develop as an expression of stress and distress or as a means of attracting parental attention; the siblings' preoccupation with their ill brother or sister may also lead to carelessness about themselves. In some instances, psychosomatic symptoms symbolically represent a sibling's concerns or fears (e.g., the sibling of a child with a brain tumor may develop intense headaches).

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