Chronic Illness in the Family - Part 1

Chronic Illness in the Family

Today's blog post will be the first part of a two-part series on chronic illness within the family system. We will look at how chronic illness in a family member can impact the family as a whole; the characteristics of chronic illness and how medical family therapy and trauma-informed therapy work to facilitate greater understanding of the illness; and clinical strategies which can be the most useful for both families and the medical establishment in navigating the features and course of chronic illness. Clinical directions utilizing EMDR-based protocols will also be covered, with ideas on how to best approach the individual and the family to promote a more integrated approach to dealing with the many features inherent in chronic illness.

Impact

Because a chronic illness lasts over time, its lengthy stay impacts families in dramatic ways, forcing family members into changing roles and identities. Onset of chronic illness foreshadows adaptation difficulties when it forces families to confront drawn-out periods of uncertainty about diagnosis, a re-shuffling of normalized health and illness beliefs, and the issue of power dynamic inherent in families.

Once family members begin living with a chronic illness diagnosis, they experience figurative and literal losses: loss of prior identity for the patient, loss of income or opportunities for work and socialization for one or more family members, and loss of direction due to thwarted goals.

In addition, families living with one or more members diagnosed with a chronic illness must deal with a healthcare system which they may not understand, and vice-versa. Long-term, ongoing interactions between family and medical practitioners may require intervention by a medical family therapist or a trauma-informed therapist to help families enact, or continue maintaining, agency against entrenched systems. This can help families and providers alike to envision and emphasize positive health outcomes instead of getting mired in confusing strain and miscommunication. A medical family therapist may be enlisted to help, as may a counselor who has experience with chronic illness, family systems, trauma, PTSD, depression, anxiety, and any other disturbances which could potentially arise when people navigate a new reality filled with uncertainty.

Chronic Illness Characteristics

Though each person and family is unique, chronic illness possesses some predictable characteristics conceptualized in a typology which can help families and healthcare providers know what to prepare for and expect.

Onset of disease can come on suddenly and acutely, as in cases like a stroke, or can gradually set in, as in Alzheimer's or Parkinson's Disease. In both instances, the disease will follow a course and will have a prognosis.

The course of a chronic disease can be progressive, meaning it advances at an expected rate; it can follow a constant direction, as in spinal injury where level of care remains predictable; or it can be relapsing/episodic, with times of stability set off by times of crisis.

Fatal outcomes describe most terminal diseases. Non-fatal and possibly-fatal outcomes exist in cases with arthritis and heart disease, respectively. Incapacitating and non-incapacitating diseases may present as visible or may remain hidden from others.

Chronic diseases run along timelines called phases. An acute or crisis phase may involve denial within a family which has not yet received a definite diagnosis, or when the diagnosis is new, sudden and alarming. During this acute phase, the family may rally together with the help of the medical family therapist. A trauma-informed counselor may also help the family begin to understand the ramifications of an acute phase, or a new diagnosis. A type of crisis intervention may be useful in that it allows family members to move beyond the throes of shock.

The chronic phase of an illness will cause readjustment for family members who have accepted the existence of the disease and must now face losses of pre-diagnostic identity while navigating the permanent nature of change. The therapist can help the family make meaning from within a safe and non-judgmental therapeutic environment.

During the terminal phase, family members may either turn to denying the outcome, or may begin preparing for endings. The patient himself will be experiencing this phase as one in which to properly say good-bye. The medical family therapist can help facilitate understanding between medical providers and family members so that any kind of medical care remains nurturing and appropriate. A trauma-informed therapist can help families prepare for grieving, and understand that a grieving process may have also begun long ago. In both instances, normalizing the family's experience will be conducive to a fuller adjustment.

So far, we have examined the impact and characteristics of chronic illness. In our next segment, we will investigate the clinical strategies that medical family therapy and trauma-informed therapy utilize; these strategies include recognition of the biological dimension of illness; family history and meaning; the importance of respect, acceptance and healthy communication; the understanding of developmental factors; externalizing techniques which can foster non-illness identity; psychoeducation and support; increasing family sense of agency and communion; and the need for empathic presence.

See you next time!

Amy Discepolo, LMHC, EMDRIA Certified Therapiust

(Article is reprinted from Bloom Behavioral Health)

EMDR and the Treatment of Psychosis

Today's blog post will examine treatment of psychosis using EMDR, or Eye Movement Desensitization and Reprocessing, a therapeutic intervention for trauma that follows an eight-phase, three-pronged protocol.

EMDR reprocesses past disturbances, present events and future scenarios, all of which may act as triggers. EMDR also helps clients develop preferred responses to situations.

EMDR can be utilized for:

• one or more events which have had a negative impact on a person's functioning;

• acute stress;

• ingrained negative core beliefs about oneself and the world;

• behaviors and feelings which a person would like to change;

• situations that trigger disturbances;

• disturbing body sensations;

• dreams or nightmares;

• disorders like PTSD, Acute Stress Disorder, and Adjustment Disorders.

• urges and addictions.

Psychotic Symptoms

Many things can trigger psychotic symptoms or episodes. The topic of psychosis is an important one for therapists and the public alike; psychosis, or psychotic breaks, can feel scary, and may be accompanied by paranoia, delusions, somatic disturbances, and other symptoms corresponding with a variety of disorders. Negative imagery may intrude into the person's awareness; these can prompt frightening future-oriented fantasies (de Bont et al., 2019).

EMDR Therapists

An article published in 2021 in the Journal of EMDR Therapy Practice & Research, can help us understand how EMDR may be utilized to help clients resolve symptoms of psychosis.

In this article, “Exploring Therapists’ Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis,” the authors Rebecca Phillips et al., address the use of EMDR as an intervention for people who are experiencing psychosis. The authors have found that at least 20% of individuals suffering through psychosis also have histories of trauma.

EMDR (Eye Movement Desensitization and Reprocessing) addresses dysfunction ally stored traumatic memories as it helps resolve PTSD symptoms, including hallucinations, delusions, mood disturbances, and self-esteem issues (Phillips, R., 2021). In addition, studies have shown that EMDR can help alleviate symptoms of psychosis, including depersonalization - and derealization, and may therefore be utilized to target psychosis outside of PTSD (Phillips et al, 2021).

In their article, Phillips et al., interviewed EMDR therapists about their experiences working with psychosis. Therapists with more familiarity around treating psychosis felt more self-confidence, since they had already acquired the ability to conceptualize how treatment should unfold (Phillips et al., 2021). These therapists also understood how trauma and psychosis are related, and therefore could help clients remain within their window of tolerance during sessions (Phillips, R., 2021). The window of tolerance keeps the client focused on reprocessing without triggering hyper or hypo-arousal. The use of stabilization techniques and exercises can help clients maintain focus on the present moment (Phillips et al., 2021).

Outside help in the form of social and family supports, and also case management, allows both clients and EMDR therapists the space to focus on the specific work to be done, the latter which includes spending quality time building a strong therapeutic alliance (Phillips et al., 2021).

Therapists were able to use EMDR with good outcomes, even when clients were experiencing symptoms like hallucinations (Phillips et al., 2021).

EMDR is very user-friendly, as it eschews homework, thus allowing both client and therapist breathing room in which change can happen (Phillips et al., 2021). Reprocessing of disturbances can happen quickly with EMDR, thereby facilitating more relief for clients (Phillips et al., 2021).

The EMDR therapy model, as a whole, has continued to develop and evolve, with new models concentrating on feeling states or more recent events (Miller, 2015).

EMDR Adapted for Psychotic Symptoms

Psychotic phenomena, when taken as targets for reprocessing using EMDR, can act as a bridge to previously dysfunctionally-stored material which can then be metabolized psychologically (Miller, 2015). Once the client and therapist have worked together to identify targets contained within the dysfunctionally-stored material, and understanding that these targets trigger clients into experiencing delusions, hallucinations, unwanted behaviors, and other disturbing, emotional and cognitive symptoms, the therapist will teach the client how to stay grounded in the present moment (Miller, 2015).

This preparation phase may last for one or more sessions, with elements also woven into succeeding sessions (Miller, 2015). During this early phase, the therapist will be helping the client understand how

• the brain works;

• how EMDR works;

• how to use the Stop signal and feel in control during every session;

• how to imagine and use the Safe Calm Place;

• how to develop and use an imaginary room that exists outside of time and space;

• and how to use metaphors during reprocessing so that clients can remain within their window of tolerance (Miller, 2015).

Our next blog post will continue examining the use of EMDR for psychosis, and will look at the next phases and how they are applied for this special topic. See you then!

(This article is reprinted)

References

de Bont, P., de Jongh, A., & van den Berg, D. (2019). Psychosis: An emerging field for EMDR research and therapy. Journal of EMDR Practice and Research, 13(4), 313-324.

Miller, P. W. M. D. M. (2015). EMDR therapy for schizophrenia and other psychoses. Springer Publishing Company.

Phillips, R., McSherry, P., Pinto, C., & Maguire, T. (2021). Exploring Therapists' Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis. Journal of EMDR Practice and Research, 15(3), 142-156.

Recovery and Religious/Spiritual Practices

I find that spiritually-oriented recovery groups and therapeutic sessions have great impact on those people who are open to exploring their own personal existential dilemmas. Whereas serious and meaningful discussions about religious and spiritual experiences may be avoided in general circles -- even to the extent of becoming subjects of derision and infantilization -- recovery groups and therapeutic sessions dedicated to uncovering ways of transformation through the medium of religion/spirituality grant a freedom of speech to clients which they may normally not find outside of this particular therapeutic process.

Recovery focused on Higher Power, God, mindfulness, Buddhism, Christianity, and even on utilizing what I call a Taoistic approach (seen in agnostic or atheistic groups) grants members an open and safe space in which to verbalize their feelings about their spirituality, enabling them to delve into zones hitherto neglected or marginalized.

Some people may come to therapy with negative frames of reference around spirituality. It's good for them to acknowledge their stances -- and to think about the causes for their breaks with inner peace and purpose in life, and their fears and anxieties about dealing with the meaning of existence.

Whether people retain positive or negative connotations regarding spirituality and religiosity, introducing concepts of mindfulness can bridge divides between clients and their inner dimensions. Helping clients become aware of new techniques for retrieving inner calm, stability, detachment and self-control can aid a client in realizing that he or she only has to breathe and become aware of the breath to begin reaping benefits.

The usage of mindfulness has found its way into the clinical setting; counselors might want to practice it for themselves so that they can effectively demonstrate to others their process. In addition, mindfulness practice grants a person a centerdness that may be palpable.

When one is in recovery and attempting to break past habits, one may become discouraged by recurring negative self-talk. Meditation aims to view the chatter in a dispassionate manner. Once one can unhook oneself from identifying with the recurring thoughts that lead to cravings, self-harm and addiction, one can begin to realize that change is possible.

Visualization techniques available in the EMDR literature may also help clients gain access to subconscious healing. When clients develop and install inner resources around connectedness, their images become imbued with positive emotions and then act as archetypes to which clients can turn in times of need.

- Amy Discepolo, LMHC (first published in InSession magazine January 2023 - https://issuu.com/fmhca/docs/january_insession_2023_2_)