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Challenges of Family Therapy for Clinicians Working with Caregivers


Palliative care helps patients cope with the difficulties of living with a chronic illness. For terminal patients, palliative care often addresses the needs of the caregivers as well as the patient. Caregivers are increasingly represented by family members. This unique role has benefits and drawbacks. Parents, children, spouses, and siblings can provide intimate and loving care to their family member in need, but carry their own emotional burden while doing so. Therefore, it is imperative that the family unit, including the caregiver, the patient, and non-caregiving members, are given the support they need during this stressful time.

One such method for relieving psychological distress is Family Focused Grief Therapy (FFGT). However, until now, few studies have looked at what issues are neglected during this process. Francesca Del Gaudio of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center in New York wanted to examine what specific aspects of care, treatment, and distress were most often tackled and most often neglected during FFGT. In a recent study, Del Gaudio evaluated the first two sessions of FFGT delivered by 32 therapists to 74 families living with cancer. She found that for the most part, the therapists focused on communication, coping, relationship behaviors, members’ roles, and family core values.

Del Gaudio also discovered that several issues were left unresolved. In particular, family conflict was only addressed in one third of the families and the development of a formal treatment plan was only discussed and finalized in 20% of the families. This raises concerns as family conflict can be exacerbated when individuals are under extreme emotional distress. Also, the family members who did not provide direct care may struggle with grief, depression, and other psychological problems after the death of the patient, which underscores the importance of a concrete treatment plan for the entire family. By initializing this while the patient is still living, all members can work to ensure dormant issues are resolved and final wishes respected. Despite the fact that there were shortcomings to the FFGT results in this study, Del Gaudio still believes that it is a viable and necessary approach. “Overall, therapists were able to adhere to the majority of interventions prescribed, suggesting that FFGT can be applied by therapists practicing in the community,” Del Gaudio said.

Del Gaudio, Francesca, Talia I. Zaider, Moriah Brier, and David W. Kissane. Challenges in providing family-centered support to families in palliative care. Palliative Medicine 26.8 (2012): 1025-033. Print.

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  • Cela January 13th, 2013 at 3:52 PM #1

    There is only so much that an outsider can do to resolve some family issues. Most family issues have to be addressed strictly by the family, as most will be unwilling to offer up any kind of resolution for a stranger. And a stranger to the situation doesn’t really know the intricacies of each family relationship and just how long most issues have been broiling anyway.

  • Connie Brown January 14th, 2013 at 4:04 AM #2

    I do think that it is useful to address the needs of everyone in instances where there is a terminally ill patient and there are many family members stepping in to help provide care. But what I don’t want to see are the needs of the ill patient being ignored just so that we can hold the hands of others. I don’t want to sound rude and callous but the person who needs the most support would be the patient and if someone else is healthy then they need to be taking care of themselves and not forcing the needs of the sick person to be ignored.

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