Managing Family Dynamics

Managing family dynamics is a common issue at the end of life and during serious illness. There are multiple personalities within the family unit and with those personalities come unresolved issues of not being heard or opinions that were not valued over many years. This results in some hurt and family dysfunction but is often seen in the form of anger. John S. Powell said, "whatever is not openly expressed in a relationship becomes a subtle form of destruction." According to Dr. Albert Ellis, "when every member of the family realizes that every individual is entitled to different feelings and needs, it can be possible to let go of unrealistic expectations. This reduces the frustration level and anger can be avoided."

It is not possible to make people grieve or pre-grieve in neat little packages, but everyone can realize that in order to allow a patient to have peace in passing, it involves everyone setting aside their personal opinions and needs to "bridge the solitude's of each unique person with healing love" (Louisa Rogers, communication consultant and trainer). Families may need guidance from a social worker or chaplain to navigate the negotiation process. With the correct direction, families can become closer than they were before and honor their loved one's life and memory.

If there are pre-existing complex interpersonal issues in a family, these can generate resistance to closure and acceptance of a terminal condition. Unresolved crisis, abuse, neglect, irrational behaviors, mental illness, years of estrangement and sudden critical terminal diagnosis and traumatic brain injury or anoxic brain injury can bring about such issues. It is best to consult a therapist, social worker or psychiatrist for assistance when a history of such circumstances could complicate the dying process and closure for patient and family. There are many professionals in the community who can assist with these situations.

Contributed by LeNae Peavey-Onstad, chaplain and Manager of Pastoral Services for Jordan Valley Medical Center and Pioneer Valley Hospital in Utah.