Academic journal article American Journal of Psychotherapy

Psychotherapeutic Issues with Family Members of Persons with Physical Disabilities

Academic journal article American Journal of Psychotherapy

Psychotherapeutic Issues with Family Members of Persons with Physical Disabilities

Article excerpt

The continual advances in medical technology have led to an increase in survival of persons with physical disabilities. This has brought with it an expanding number of rehabilitation services available and the heightened social and political awareness regarding persons with disabilities. The adjustment process for the person with a disability has been well described(1,2) as have the approaches to family therapy directed at the adjustment process of the family group with a member who has a disability.(3,4) With such an increase in the population of those with disabilities has come an escalation in the number of family members who are experiencing their own stress reactions in response to the disability. These family members are referred increasingly for individual psychotherapy to help them cope with a new disability in the family or with the stress due to a chronic problem in a preexisting one. Similarly there may well be an increase in the number of those persons already in treatment who are confronted with such difficulties.


The impact of a physical disability on family members is no less complex than on the person with the disability. Multiple factors determine the influence of the disability on the family member, some of which may be similar to that of the person with the disability and some far different. The focus of this paper will be on issues to be considered when a family member of a person with a disability is seen in psychotherapy, with the disability (longstanding or recent) presented as the reported precipitating factor. The comments also should be applicable when the issue of physical disability is brought to an ongoing treatment as a stressor. In addition only disabilities that arise from early adulthood onward will be addressed, and not congenital disabilities or those that strike during childhood.

The family member (patient) who comes to treatment may be in crisis or in a chronic nonacute state of dysfunction. Feelings of desperation, depression, anxiety, confusion, conflict, guilt and a sense of being overwhelmed are not uncommon following recent disability. In the initial stages following onset while the person with the disability is being treated, family members, such as spouses, may often not have had the opportunity for support from professionals to help deal with their own emotional crisis. By necessity they have been the responsible ones. Even in the initial stages of rehabilitation this situation may persist. Family members have often been encouraged to become part of the rehabilitation effort as part of the rehabilitation team. Such a positive stand on occasion leads to family members assuming the role of cotherapists. Such a role may be supported by their own denial in response to the event and may limit their ability to emotionally process what has happened. For although the disability has impacted their loved one, it has also happened to them.

People who suffer traumatic disabilities experience common stages of adjustment.(2) The natural history of reactions to disability is similar to those posited by Kubler-Ross in her work on the knowledge of one's own impending death.(5) The stages she refers to are denial, anger, depression, and adjustment. It has been my observation that such stages may be seen as common human reactions to the processing of almost any major loss. It has also been observed that family members experience a similar loss process, the intensity of which is commensurate to the relative meaning of the disability for them and the relationship to the person with the disability.

Although the focus here is on individual psychotherapy, a familiarity with some of the conceptualizations of family therapy and disability may be useful in the work with family members of those with disabilities. In family systems therapy the family unit is the object of treatment and not the individual. There must be accommodation to major changes (transitional stages) in the development of the family or problems result. …

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