Family Focused Grief Therapy: A Model of Family-Centered Care during Palliative Care and Bereavement

By David W. Kissane; Sidney Bloch | Go to book overview

relationships are intrinsic to human fulfilment and our most valued relationships are generally found within our families.


Setting the scene

Serious medical illness has a profound impact on family life, while families also shape behaviours associated with the detection and clinical course of the illness. Yet families have so often been overlooked or, at best, tolerated in health care settings. Palliative care brings the family into sharp relief, for they can no longer be passed over if the objectives of the hospice are to be realized. Relatives are not only carers, but also second-order patients in this system of care. Families need help with their role since death is now less familiar (at least in western society), yet mortality inescapable. A structured approach that supports the family in their caring also guides them through this journey of illness, death and bereavement.

Several barriers can impair a family's ability to care, but nothing is more curtailing than when its own intrinsic functioning limits its adaptive capacity. The family's ability to communicate openly, resolve differences, cooperate with and support one another determines its success in accomplishing its goals. We would argue that families can be helped to operate more effectively – the prime objective of the intervention described in this book is to enhance family functioning as the means to this end.

Our research developed across a decade from initial observational studies into the prevalence of psychosocial morbidity in families into a search for patterns of family relationship that contributed to this morbidity. The first author (DK) completed his doctorate developing a typology of family functioning, which was shown to be predictive of psychosocial outcome from a stressor event such as bereavement. This in turn led to the development of an intervention, family focused grief therapy, which is described in this book. It is a supportive–expressive family therapy that aims to promote cohesion, effective communication and adaptive resolution of conflict – a comprehensive model of family-centred care for palliative care and bereavement, but a programme that is surely adaptable to other settings of chronic illness, loss or trauma that disrupt the family life cycle.

FFGT is intimately bound up with systemic thinking about the patient and family within the community, including the health professionals with whom they interact. Within this perspective, the family is best defined as people in a committed relationship from which they shape a sense of identity (Chilman et al. 1988). This locates the family in a cultural milieu, which influences its structure, beliefs and dynamics. Anthropologically, the family is the unit of care that promotes the well-being and survival of its descendants. Ecologically, the family works together in order to ensure its sustenance and security, but its functioning needs to be placed within a

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