“In Sickness and In Health: How to soften suffering when illness strikes ” Smart Marriages 12 th Annual Conference San Francisco, CA July 4, 2008 (Not to be copied or distributed without permission of the authors)

Lorraine M. Wright, RN, PhD Professor Emeritus of Nursing University of Calgary Janice M. Bell, RN, PhD Former Director, Family Nursing Unit University of Calgary Editor, Journal of Family Nursing

MISSION: Create and disseminate practice knowledge about illness suffering and family healing

WEB SITES Family Nursing Unit Family Nursing Resources Journal of Family Nursing

REFERENCE BOOKS Wright, L.M., & Bell, J.M. (in press). Beliefs and Illness: A Model for Healing. 4 th Floor Press: Calgary, Alberta, Canada. Wright, L.M. (2005). Spirituality, Suffering, and Illness: Ideas for Healing. FA Davis: Philadelphia. Wright, L.M., & Leahey, M. (2005). Nurses and Families: A Guide to Family Assessment and Intervention (4 th ed.). FA Davis: Philadelphia. Wright, L.M., Watson, W.L., & Bell, J.M. (1996). Beliefs: The Heart of Healing in Families and Illness. Basic Books: New York.

What illness will you most likely experience in your couple relationship? A QUESTION TO PONDER

Couples and Illness (Weihs, Fisher, & Baird, 2002) “Illness, disability, and death are universal experiences in families. Chronic illness and life-threatening illness [physical or mental illness] confront all of us with some of life’s greatest challenges. The question is not if we will face these issues but rather when, what condition, how serious, and for how long?”

Marriage Matters in Illness When one member of a couple develops a serious illness, the lives of both partners are likely to be affected. Emotional, relational, spiritual issues are reported to be of greater concern to seriously ill couples than physical symptoms and medical interventions. Quality of marital interactions and in particular, levels of support by the spouse, is a strong predictor of adaptation to illness and health outcomes.

Marriage Matters in Illness The nature and progression of illness challenges couples by creating changes in communication, roles and responsibilities, and how they adjust to the demands of illness. Adaptation to illness is influenced more by couple functioning than by the severity of the illness. ( Kuyper & Wester, 1998; McLean & Jones, 2007; Rolland, 1994; Skerrett, 2003 )

Couples’ Beliefs about Illness

Facilitating Beliefs of Couples Experiencing Illness “We” are experiencing this illness. A good wife/husband is present and emotionally available. We feel supported by our family and health care professionals. Illness is an opportunity for relational growth.

Constraining Beliefs of Couples Experiencing Illness This illness is “my” or “his” illness, not “our” illness. Talking about illness with my partner is too scary or too difficult. We are overwhelmed by this illness. I don’t have the skills, knowledge and/or time to care for my partner.

1.Invite, listen to, and acknowledge the couple’s illness suffering. Illness narratives include stories of sickness and suffering that need to be told and witnessed. (Wright, 2005; Wright & Bell, in press; Wright, Watson, & Bell, 1996) Ways To Soften Suffering

2. Offer commendations. All couples have strengths, often unappreciated or unrealized. Conversations of “goodness” (Limacher & Wright, 2003, 2006; Wright, 2005; Wright & Bell, in press; Wright, Watson, & Bell, 1996) Ways To Soften Suffering

3. Ask questions that invite reflection. Interventive questions, reflexive questions (Loos & Bell, 1990; Tomm, 1987, 1988; Wright & Bell, in press; Wright, Watson, & Bell, 1996) Ways To Soften Suffering

4. Write a therapeutic letter. (Moules, 2002, 2003, in press; White & Epston, 1990; Wright & Bell, in press; Wright, Watson, & Bell, 1996) Ways To Soften Suffering

Softening Illness Suffering in Couples: What’s in a Name? The context of the practice and the beliefs, competence, and confidence of the helping professional will determine what this systemic and collaborative practice is called: Family Meeting for consultation and education Marriage Consultation Marriage Counselling Family Systems Nursing/Family Nursing Couples therapy Medical Family Therapy

All of the publications of Family Nursing Unit faculty ( Wright, Bell, Moules ), students, and graduates are archived for free public access in the Family Nursing Unit Dspace Collection at the University of Calgary Library. See:

For workshops, training, and developing demonstration projects in health care settings about the clinical practice models: ILLNESS BELIEFS MODEL TRINITY MODEL CFAM, CFIM Dr. Janice Bell & Dr. Lorraine Wright