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

6 Challenges and problems
in the delivery of family
focused grief therapy

Although all the families we have worked with are unique in one way or another, patterns crystallize over time that involve specific, recurrent challenges. The delineation of strategies that facilitate resolution of these will optimize our approach. These challenges are basically either predicaments intrinsic to the process of therapy or major life events. The former include engaging family members reluctant to participate, setting realisticgoals, working in the home, conflict, sustaining the therapeutic focus, the uncertainty of prognosis, and dropouts. We discuss these in this chapter and offer helpful comments on the therapist's role, interventions and countertransference.

Major life events are the second form of challenge that adds to the family's strain. They include the occurrence of two or more patients with cancer in the same family, the alcohol abusing father, the mentally ill member, chronicphysical illness, blended families following divorce and remarriage, and migrant families, to name a few. We will use examples from our work to illustrate these respective issues in Chapter 7. For now, we will concentrate on some of the challenges that arise within the process of therapy.


Engaging reluctant members

When a family's difficulties are long-standing and entrenched (for example hostile families), they can be difficult to engage in therapy. Indeed, hostile families are the most problematic, since they intrinsically reject professional aid. On the other hand, a terminal illness powerfully motivates a family to work together. Palliative care therefore offers the best chance during the cancer journey to assemble the family. Joining the family at this point

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