When Family Falls Ill

When Family Falls Ill

A medical diagnosis of any life-threatening, chronic, or terminal condition is a life-changing event. Such a serious diagnosis affects not only the person receiving the diagnosis, but also the members of their family. Counselors can provide much-needed care for individuals coping with a relative’s serious diagnosis. Whether it represents a new development for an existing client or becomes the reason for seeking treatment, Counselors should be prepared to help clients navigate the challenges around a family member’s illness.

Jillian Blueford, PhD, NCC, LPC, CT, FT, explains that certain emotions and responses are common when a client’s family member receives a serious diagnosis.

“What first comes to mind is the shock, maybe some anger, a lot of questioning,” says Dr. Blueford. “If it's for a family member, I'm also thinking about the helplessness that may come in. And there’s already that grieving process. Even if the diagnosis is not terminal, if it is going to change that family member's mobility, cognition, and therefore the relationship the client has with that family member, then there's going to be loss and grief in that.”

Other complicated feelings may involve blame or shame, directed outward or even inward. This is particularly true in the case of an accident or other precipitating event.

“An accident may involve other people,” explains Dr. Blueford. “Was it at the fault of somebody else? Was it malpractice? Was it something that could also elicit some anger, some blaming, perhaps even some shaming of, ‘I should have told them not to do this,’ or ‘I should have went with them,’ to ‘I think I could have prevented the accident’?”

Fundamental to supporting a client is recognizing any misalignment between what they want to do for their family member and what they can actually do, and helping the client to process this, explains Dr. Blueford.

“Naturally they may want to help,” says Dr. Blueford. “And the family member may not want that immediate help. They have got to also figure out what's happening with them and how they're going to process this and move forward. Sometimes having a lot of help quickly and in your face can be overwhelming. And so that may cause them to want to push back a little bit.”

In this situation, a Counselor can help their client to process their own feelings about the situation and communicate with their family member in a way that doesn’t add to their stress.

“Whatever unfiltered things that may be coming up, let’s try not to judge them and begin to reconcile and then how do we develop the skills to approach that family member to say ‘How can I be a best support for you?’ . . . If they feel powerless, where can they try to focus that level of energy and maybe advocacy or help that they want to in a way that's going to be supportive for their family member?”

A client’s desire to aid and support their family member likely comes from a positive relationship. However, familial relationships may be complicated, strained, or even negative. Where such is the case, these complications affect the therapeutic process.

“It adds an extra layer,” says Dr. Blueford. “Maybe the desire to help or to want to be there is still there, but now there's this stickiness of I can't just call you as freely as maybe I used to or I want to. Or maybe I don't want to. Maybe I'm empathetic. I don't wish ill on you. And I don't necessarily want to reignite a relationship because something has happened.”

Social pressure to behave in a certain way or comply with traditional family roles can add to the stress for a client who does not have a close or positive relationship with the relevant family member.

“I've seen this with adults who maybe don't have the best relationship with their parents and then parents get sick or something happens, and those familiar roles in society are still there,” says Dr. Blueford. “But if the children don't have a positive reciprocal relationship, then it can also create some pressure of, ‘I'm supposed to just stop my life and maybe push aside any hardships that we've had because now maybe I need to become a caregiver.’”

In these situations, a Counselor should support their client as they decide the level of assistance or caregiving that is right for them, regardless of societal pressures.

“This could mean we're opening up conversations again and maybe some healing may happen,” says Dr. Blueford. “It could also reinforce to the client, ‘OK, maybe this is why I put some boundaries on this relationship. And even though this person is now dealing with a medical diagnosis, it doesn’t erase the pain that they’ve caused me.’”

Treatment goals are likely to focus on processing initial feelings and conceptualizing what the situation means for the client's relationship with their relative. As always, goals should be based on what the client wants to achieve.

“In the counseling space, we can discuss the impacts if there are changes in perceived roles or responsibilities,” says Dr. Blueford. “If the diagnosis is terminal, then that anticipatory grief can come up. There's no goal to end grief, right? Rather, how do you help it adapt to your day-to-day and find ways to allow grief to enter those spaces when it's needed?”

Another goal for some clients may be to simply gain a better understanding of their family member’s condition and its implications. Counselors can help with this important educational component. Clients may need assistance to find trusted sources and avoid “doom scrolling” or misinformation, says Dr. Blueford. A client who attends medical appointments with their family member may want to prepare questions or even help to obtain a second opinion.

Societal perceptions and attitudes toward illness can vary greatly based on the age of the ill person. This can affect the support a client receives from their peers, which influences what help they need in counseling.

“Not that it hurts less, but we just expect death to occur when we are older,” says Dr. Blueford. “Compared to children—it’s in our world view that children don't die under any circumstances, and so when a child does receive a diagnosis, it can definitely limit outside support, especially if it’s terminal.”

Parents confronting a severe diagnosis for their child may find a surprising lack of support from their community, because others are unprepared to deal with the reality of the situation.

“If we provide more support, that means we have to accept that things like these happen to children,” explains Dr. Blueford. “For children who receive a different medical diagnosis—and we see this a lot even in the past couple of years about medical diagnosis, mental health diagnosis—we want to have a reason and almost something to blame for what happened. Whereas with older adults, our mindset is like, well, we get older, our bodies start to decline, things happen. We don't have that same openness when it comes to children.”

In this search for a cause, parents may blame themselves or face stigma, says Dr. Blueford: “Did we do something? Did something happen in pregnancy? Did we make a decision afterwards that, you know, they were OK one day and the next day they weren’t?”

For an adult client whose parent or older relative receives a diagnosis, there are a variety of resources to provide support. A Counselor can help their client to find these resources and communicate with peers who are going through a similar experience.

“Because if more people are taking care of their aging parents or older family members, there’s such a cultural context of taking care of older family members that just feels more part of the norm,” says Dr. Blueford. “You can find more adults that you can connect with. There’s a growing focus and literature on caregiver support and making sure that caregivers don't burn out when taking care of their elderly family members.”

When helping a client to deal with a family member’s severe diagnosis, the client’s age is an important factor in determining a Counselor’s methods. Adult clients are likely to spend a lot of energy contemplating their history with the relative. They may grieve for a lost or changed future. A Counselor can help the client to process these feelings and communicate with their loved one, explains Dr. Blueford.

“And so for adults, I would do and have done ways for them to self-reflect on those pieces and then choose what do they share with others and what is just a self-reflection piece,” she says.

Children and adolescents tend to look at the situation differently. They may have trouble understanding just what is happening or what it means for their life. A Counselor can help a young client to conceptualize the diagnosis in an appropriate way.

“I would first want to start with what information do they have and how are they processing it. I don't want to add more than what has been communicated to them by their family. If they're really young, then understanding the finality of the illness or of life is hard to do.”

A variety of tools and interventions are appropriate for children. A Counselor can use play and other creative outlets to help a young client conceptualize the events in their life. Hands-on activities like drawing, sand tray, and dolls are all useful for children.

While these sorts of activities are more universally appropriate with children, a Counselor may consider such activities for some adult clients too.

“I have worked with adults that have also engaged in those things, whether it’s using some type of physical pieces to represent what they are experiencing,” says Dr. Blueford. “That could also be journaling. Especially if they are older and that feels like more of an avenue for them to release or share what's going on.”

For an adult client caring for an ill child, it can be difficult or impossible to share everything they wish with their loved one. Whereas an adult family member would be fully aware of their diagnosis details and implications, a child will not be included in all conversations with doctors.

“So sometimes it can be harder for parents to share what they really want to share,” explains Dr. Blueford. “Sometimes either writing a letter or the empty chair technique—something where they can share it in a way that doesn’t have immediate consequences or there’s no one there to push back or anything can be really helpful.”

In the case of a young client, these techniques can be effective for different reasons. Role-play, empty chair, and similar practices can help a child process the feelings they want to share with their ill family member or with other adults in their life.

“I'm always a big fan, especially if the child is a client or for adults if they’re supporting or caring for ill children, of the use of books," says Dr. Blueford. “It can be books related to what is happening in their life. It could also be books that have more of an abstract connection to it. We talk about the characters, what's going on with them, externalize it a bunch and then say, ‘Does this relate to anything that's happening in your life?’ Or if it’s an adult client that is trying to be around their ill child or have conversations or process what's going on with them, ‘How do we utilize books to kind of bridge that gap and see what connects for us internally?’”

In addition to counseling, adult clients may benefit from talking with others going through a similar experience.

“Support groups can be really helpful,” says Dr. Blueford. “Oftentimes, especially in situations of caring for an ill child, it can feel so isolating. And so to be around others who can sort of maybe get it can be really gratifying and helpful and supportive.”

Dr. Jillian Blueford (She/Her) is a Clinical Associate Professor and Director of the School Counseling Program and related certificates at the University of Denver in Colorado. A Licensed Professional Counselor, National Certified Counselor, and Fellow in Thanatology, Dr. Blueford’s career spans education, clinical practice, research, and service. Since 2014, she has honed her expertise in grief counseling, supporting individuals and families across diverse settings, including schools, inpatient residencies, community agencies, and private practice. Her scholarship focuses on grief counseling training, trauma-informed grief counseling, and child and adolescent grief. Dr. Blueford’s research contributions include peer-reviewed publications, book chapters, webinars, panels, podcast features, and presentations at regional, national, and international conferences.

Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.