How an individual’s crisis affects the family
Reprinted from "Families and Crisis" issue of Visions Journal, 2017, 12 (4), p. 22
Jay* was encouraged by his psychiatrist and his family to come see me as a counsellor. As soon as he came into my office for our first meeting, before we even had a chance to sit down, he rushed into an explanation of why he was “here,” in therapy. He told me that getting out of bed, making food, eating, showering, even undertaking simple tasks like checking phone messages or emails, had become difficult. He also said he was struggling to keep up with his coursework at university. He was not seeing much of his friends and did not feel like returning their calls. He was not talking much to his family either, even though they were “constantly on his case,” checking in with him and telling him they felt lost as to how to help him.
As he spoke, Jay sounded agitated and frustrated. He looked guarded, sitting as far away on the couch in my office as possible, barely lifting his gaze from the floor. His hair was messy, and I suspected from their wrinkled appearance that his clothes had come out of the laundry hamper. Jay explained that he was feeling overwhelmed and depressed. His voice dropped in volume as he told me hesitantly that he was having thoughts about “wanting to die to stop the pain” and was occasionally purposefully hurting himself. He also blamed himself for the recent breakup of a romantic relationship, for worrying his family and for pretty much everything that he felt had gone wrong in his life. He said that he was feeling embarrassed about mistakes he had made in the past. He felt stuck, confused and helpless.
Jay was in crisis.
What is crisis?
The word “crisis” derives from the Greek krisis (decision) and krinein (decide). In English, the word crisis often carries with it the sense of a “decisive point.” Jay was going through an emotional crisis; he had reached an emotional tipping point—a point of decision.
When my clients are dealing with an emotional crisis, they frequently tell me that their usual way of dealing with life has become disordered. Often I see my clients in crisis confused about their obligations and social connections. Some scholars have suggested that during an emotional crisis, how we see reality and think about our environment changes. We lose sight of what is actually happening. We think about what should be rather than accepting what is.1 Naturally, this affects our ability to work and upsets how we relate to colleagues, friends and loved ones. During an emotional crisis, we frequently remember other times of hardship or crisis. Like Jay, we mull over old anxieties and feelings of guilt, which makes it even harder to move forward. We may feel anxious, irritable, guilty, ashamed, hostile or depressed. Our appetite, sleep and overall energy may also be affected.
As Jay continued to talk, I learned that he had moved to British Columbia a few months previously to attend university. His two sisters were also going to university in the Lower Mainland. He spoke of a good relationship with his family.
I also learned that Jay saw himself as a “very sensitive, anxious” person: he did not remember a time when anxiety was “not here.” He talked of how anxiety had affected his life—from his needing extra help with school work to his having trouble creating and maintaining friendships.
His low mood, though, was something new. Though he had been the one to end the romantic relationship, he felt sad and said that life had changed dramatically. He felt frustrated by constant calls from family, even though he knew they were trying to help. He was scared by his sense of helplessness but did not see how he could take control of his feelings.
After a few sessions with Jay, I received an email from his parents. They wanted to share with me their view of Jay’s struggles and to assure me that they were ready to do whatever was needed to help their son. They were worried about his well-being and were not sure how to support him in a helpful way. As Jay had given me his consent to share with them certain details, I was pleased to be able to do so and happy that the family wanted to become involved. From my conversations with Jay, it had become clear that his need for support and the aid offered by his family were not compatible; I hoped we could change that.
In my clinical experience, family can be an invaluable source of support when people are experiencing crisis. However, when a member of a family is in crisis, the crisis affects the family as well. Understanding how an individual’s crisis affects the family support network helps to ensure that the aid being offered is the right kind of aid.
Families are like complex systems. They work well when there is a balance between the internal and external forces that affect them. Internal adjustment processes—the family’s ability to cope with everyday stresses and life events—respond to external changes.1
In Jay’s family, there was balance in knowing that Jay was succeeding in school and managing his anxiety well. When he suddenly experienced crisis, the family system became distressed. This in turn created more tension for the entire family. New internal dynamics began to emerge; although these were intended to restore the balance in the system, they weren’t very successful. When Jay ended his romantic relationship, his mood dropped, which affected his school and his other social relationships; consequently, his parents’ worry began to increase. They started calling more frequently, asking more questions, giving more advice, all with the aim of restoring the previous balance. They were likely also trying to manage their own fears—the less they knew, the more they wanted to know so that they could help.
Jay requested that I meet his parents without him present. He believed it would be more helpful if I could listen to his parents’ views without them worrying about how he may react or feel in the moment. I agreed to do as he requested. This situation was not atypical. In my experience, families often choose to work together with me in some capacity. Sometimes family members simply wish to share their perspective, sometimes they wish to take part in a session, with or without my client. How we proceed depends on many things, including the comfort level of my client, geographical distance and financial factors.
Jay’s parents were thankful for the opportunity to meet with me. Although they knew that Jay had been dealing with anxiety for a long time, our discussion clarified that they did not know how his anxiety was affecting his life in the moment. I also learned that they did not know much about mood disorders, which was important because Jay’s doctor had recently diagnosed him with depression. Finally, I heard more about Jay’s interests, talents and strengths.
In my next meeting with Jay, we talked about the need for change in all parts of the family system in order to bring back balance. We discussed how I could help with that process, and mom and dad subsequently joined us for a number of sessions. Jay was able to explain how anxiety and depression affected his life, and mom and dad heard what it was like for Jay to feel depressed and anxious. Jay was able to discover and talk about his biggest areas of struggle, and his parents learned how they could offer more help and support. Finally, they also learned how to talk about Jay’s struggles in a way that was helpful and empowering, for him and for themselves.
In the course of our work together, Jay’s mood began to improve and his anxiety decreased. He improved his ways of managing anxiety and depression and made changes to promote a healthier lifestyle. His relationship with his parents improved as well.
Working with Jay and his family was a challenging and emotional experience. Much like other families, they struggled to accept the ways that depression and anxiety affected their child. In our sessions together, tempers sometimes flared and emotions were fragile. Blame was cast, and in the heat of the moment, people labelled each other and each other’s behaviour—often in ugly and unkind ways.
At times, I felt stuck in my work with them because they felt stuck in their inability to see beyond their own needs. I felt frustrated with the rigid expectations they had. They felt frustrated that the process of change takes times to unfold.
And then there were times when we celebrated empathy, cooperation, team work and progress.
For me, working with clients who face chronic mental health challenges highlights the need to include the family in the process of change, even if for a limited time. The cycle of suffering and recovery so typical of chronic conditions places tremendous stress on the person who struggles with them, but it also places stress on their family. In my experience, the only way to ensure harmony even in difficult times is to empower the people involved—and that includes family, too.
About the author
Valentina is a Clinical Counsellor at the Mood Disorders Association of BC and a Practicum Supervisor at a graduate counselling psychology program. She serves on the executive council of the International Association for Counselling, has presented at a number of conferences and has co-facilitated workshops for counselling professionals
*pseudonym. This composite narrative incorporates the experiences of several clients in my practice. Names and certain facts have been changed to protect the identity of individuals, but the story and the interventions I discuss are an accurate reflection of clients’ various experiences and my approach to working with clients and their families
Caplan, G. (1970). The theory and practice of mental health consultation. New York: Basic Books.