Enhancing resilience in siblings of children with cancer

Enhancing Resilience in Siblings of Children with Cancer: A group intervention Kelsey Harper, MA Gerald Michaels, PhD Rhoda Olkin, PhD

Enhancing Resilience in Siblings of Children with Cancer: A Group Intervention
Significant numbers of families are suddenly thrown onto a vastly different and unexpected path, one that involves intensive and invasive treatments, fluctuations between health and sickness, threats to the family system, and severe emotional distress. The new path begins when a child is diagnosed with cancer.

Following diagnosis, families have a very short time to adjust before the ill child becomes very sick. During treatment, ill children are consumed by exhaustion, severely limiting or completely eliminating all activities in order to rest and recover from treatment.

Normal family development is stalled and diverted onto a new path as the entire family becomes “sick.” In normal families, the family life cycles travel along a path involving stages of relational changes. As the family develops through marriage, the birth and raising of young children, power struggles through adolescence, launching children, and moving on into later life (Carter & McGoldrick, 2005).

When a normal developmental transition happens at the same time as the unpredictable stressful event of the diagnosis of cancer in a child, family members can become significantly distressed (Carter & McGoldrick, 2005).

As parents redefine their roles in reference to the ill child, siblings of the ill child, are often left to reinterpret their roles within the family. Siblings may be excluded from the new family tasks of caring for the ill child, leaving siblings struggling to identify a role within the family, a relationship with the ill child, and a sense of purpose and belonging within the family (Woodgate, 2006).

Along with feeling the loss of a place within the family, siblings may experience significant psychological symptoms in the face of the stressors accompanying the diagnosis of the ill child. Siblings typically show symptoms of anxiety, depression, posttraumatic stress disorder, isolation, and guilt, rather than symptoms of aggression and anger, making the struggles of well siblings harder to notice (Sharpe, 2002).

Siblings can respond in a resilient way, that involves their redefining their roles as a caregiver for the family and ill child, and their taking on responsibility and purpose in the family. Shifting their role provides a new, significant and prominent role for the sibling to play. Including them within the family tasks, rather than excluding them, promotes well-being. As well, many siblings learn to respect healthfulness, to identify and develop capability as opposed to disability, and to show empathy and compassion (Fleitas, 2000).

Siblings’ to cope with adversity, respond with strength, and develop normally in spite of challenges, shows resilience. Resilient tools are developed throughout the lifespan as healthy, adjusted responses to adverse events (Hirayama, & Hirayama, 2001). These tools can be enhanced through providing social support and a secure, safe space to complete normal developmental tasks.

Working with siblings can enhance resilience; building protective tools to respond to the stressors that are a part of being a sibling of a child with cancer can assist with strength and growth and can promote a strong self esteem.

The purpose of the group intervention is to enhance resilience in siblings of children with cancer. This will provide siblings with the strength and tools necessary to effectively cope with the variable, ambiguous, and unpredictable process of cancer.

The group is for elementary school age siblings of children with cancer. The group spans 12 weeks and covers topics relevant to sibling experiences. The sessions include various play activities, games, story telling, role plays, arts and crafts, and family interactions.

Each group session will last one and a half hours and all sessions will be organized around a schedule for every session that contains three parts. The first part opening each session is the “Feelings Tree”, followed by “Roses and Thorns” activities. Closing each session is the “Siblings Book” activity.

Feelings Tree
As participants arrive at session, they will choose an image of a facial expression that shows how they are currently feeling at that time and place it on the “Feelings Tree” by their name. This activity focuses on identifying and expressing emotions, and includes the experience of emotions as a regular activity throughout the group.

Roses and Thorns
Once everyone has arrived, each participant will take a turn in describing his or her “Roses and Thorns” of the week: his or her best moment, and his or her worst moment. This gives siblings the space to talk about their own experiences, good and bad, in a supportive space.

Siblings Book
Closing each session will be a review of important points of the day, followed by the activity of adding a page to each participant’s “Siblings Book”. The Siblings Book has one page for every session of the group where siblings draw a picture of or write about their favorite part or most useful part of the session. At the end of the 12 weeks, siblings will take this book home as a reminder of the work they did in the group.

Plan of sessions
Session 1 Introduction
Session 2 Myth Busters
Session 3 Family Structure
Session 4 Sibling Relationship
Session 5 Understanding Feelings
Session 6 Communication
Session 7 Scary/Brave Stories
Session 8 Scary/Brave Stories
Session 9 Loss, Grief
Session 10 Social Development
Session 11 Social Development
Session 12 Graduation

Session one is an introduction to the group to familiarize siblings with this group, group rules, privacy, and introduce their families to the group.
Session two is Myth Busters day that includes activities to talk about common myths siblings have about cancer, their family, and their experiences.

Session three looks at the family of the sibling, relationships, and re-establishing a role within the family.
Session four focuses on the sibling relationship by talking about perceptions of others, their unique relationship, and fun things they do together.

Session five talks about emotions, expressing, and communicating feelings and building tools to cope with feelings.
Session six builds communication skills by practicing talking about difficult things with family members, friends, and peers.

Session seven starts a two-session series that reflects upon past times of coping despite the challenges.
Session eight concludes the two-session series, using the siblings’ own coping to provide tools siblings can use now.

Session nine examines possible experiences of loss and grief that siblings may face. As this is a very risky subject, it will be handled sensitively. Siblings review feelings and coping tools to help manage changes.

Session ten starts another two-session series that provides opportunities for social development. In this first session of social development, siblings will play a team-building game, and talk about different after school activities.
Session eleven concludes the two session series of social development where siblings get to play different games, and activities to build social skills.

Session twelve terminates the group with a graduation ceremony. Siblings and their families get to celebrate their accomplishments in group.

Your help
Please follow the link to the online survey to tell me your feelings about the group, give feedback, and offer advice on the needs these families face.
http:// alliant.qualtrics.com /SE?SID=SV_8vQgHCC5h6Ut2K0

Thank you!

References
Carter, B. & McGoldrick, M. (2005). Siblings through the life cycle. In B. Carter & M. McGolderick (Eds.), The Expanded Family Life Cycle (pp. 153-168). Massachusetts: Allyn & Bacon.
Fleitas, J. (2000). When jack fell down…Jill came tumbling after. The American Journal of Maternal Child Nursing, 25 (5), pp 276-273.
Hirayama, H., & Hirayama, K. (2001). Fostering resiliency in children through group work: Instilling hope, courage, and life skills. In Kelly, T.B., Rossi, T.B., & Palombo, S. (Eds.), Group work: Strategies for strengthening resiliency (pp 71 – 83). Birmingham, NY: The Haworth Press.
Sharpe, D. (2002). Siblings of children with a chronic illness: A meta-analysis . Journal of Pediatric Psychology, 27 (8), pp 699-710.
Woodgate, R. L. (2006). Siblings’ experiences with childhood cancer: A different way of being in the family. Cancer Nursing, 29 (5), pp 406 – 414.

Enhancing resilience in siblings of children with cancer

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Enhancing resilience in siblings of children with cancer Presentation Transcript