In Sickness and In Health:

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In Sickness and In Health How to soften
suffering when illness strikes Smart Marriages
12th Annual Conference San Francisco, CA July 4,
2008 (Not to be copied or distributed without
permission of the authors)
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Janice M. Bell, RN, PhD Former Director, Family
Nursing Unit University of Calgary Editor,
Journal of Family Nursing Email
jmbell_at_ucalgary.ca www.janicembell.com
Lorraine M. Wright, RN, PhD Professor Emeritus
of Nursing University of Calgary Email
lmwright_at_ucalgary.ca www.lorrainewright.com
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MISSION Create and disseminate practice
knowledge about illness suffering and family
healing
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WEB SITES Family Nursing Unit www.ucalgary.ca/NU/f
nu Family Nursing Resources www.familynursingresou
rces.com Journal of Family Nursing http//jfn.sage
pub.com
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REFERENCE BOOKS
Wright, L.M., Bell, J.M. (in press). Beliefs
and Illness A Model for Healing. 4th Floor
Press Calgary, Alberta, Canada. Wright, L.M.
(2005). Spirituality, Suffering, and Illness
Ideas for Healing. FA Davis Philadelphia. Wrigh
t, L.M., Leahey, M. (2005). Nurses and
Families A Guide to Family Assessment and
Intervention (4th 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.
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A QUESTION TO PONDER
What illness will you most likely experience in
your couple relationship?
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Couples and Illness
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 lifes
greatest challenges. The question is not if we
will face these issues but rather when, what
condition, how serious, and for how long?
(Weihs, Fisher, Baird, 2002)
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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.

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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)

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Couples Beliefs about Illness
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• 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.

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• 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 dont have the skills, knowledge and/or time to
  care for my partner.

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Ways To Soften Suffering

• Invite, listen to, and acknowledge
• the couples 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)
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Ways To Soften Suffering
2. Offer commendations. All couples have
strengths, often unappreciated or unrealized. Con
versations of goodness
(Limacher Wright, 2003, 2006 Wright, 2005
Wright Bell, in press Wright, Watson, Bell,
1996)
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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)
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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)
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Softening Illness Suffering in Couples Whats
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

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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
https//dspace.ucalgary.ca/handle/1880/44060
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For workshops, training, and developingdemonstrat
ion projects in health care settings about the
clinical practice models ILLNESS BELIEFS
MODEL TRINITY MODEL CFAM, CFIM Dr.
Janice Bell Dr. Lorraine Wrightjmbell_at_ucalgary.
ca www.janicembell.comlmwright_at_ucalgary.cawww.
lorrainewright.com