WORKING WITH SIBLINGS: NEEDS AND INTERVENTIONS Dr Jo Smith Consultant Clinical Psychologist, Early I

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WORKING WITH SIBLINGS NEEDS AND INTERVENTIONS
Dr Jo Smith Consultant Clinical
Psychologist, Early Intervention Lead,
Worcestershire Mental Health Partnership NHS
Trust, UK
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The nature of sibling relationshipsSibling
relationships outlast marriages, survive the
death of parents, resurface after quarrels that
would sink any friendship.  They flourish in a
thousand incarnations of closeness and distance,
warmth, loyalty and distrust.  Erica E. Goode,
"The Secret World of Siblings," U.S. News World
Report, 10 January 1994

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Sibling Relationships

• Longer duration than relationships with parents,
  partners, peers or children
• Persisting with varying degrees of intimacy and
  investment throughout the life cycle
• Adult sibling relationships tend to be renewed as
  children mature and leave home
• Important in maintaining morale in old age
• Provide companionship, emotional support and
  practical help, particularly in childhood and
  adolescence
• Sibling bond intensity influenced by degree of
  access being raised together, close in age,
  spending time together over a period of years,
  shared friendships tend to have more intense
  bonds

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Sibling research

• Little focus on siblings despite importance in
  life cycle and potential vulnerability of well
  siblings
• Siblings report pervasive impact on lives and
  similar subjective burden to parents
• Few published studies on sibling experiences with
  recent onset psychosis
• Impact of onset and diagnosis have largely
  involved retrospective accounts
• Studies with siblings have identified guilt, fear
  about personal vulnerability, shame, anger, grief
  and loss, need for support, disruptions of normal
  development and feelings of parental neglect
• Siblings show similar levels of initial and
  current grief as parents (Miller et al 1990
  OShea, Fadden and Smith(2003 Fisher and Steele
  2004)
• Siblings more likely to resolve grief reactions
  to diagnosis compared to mothers (Fisher and
  Steele 2004)
• Family intervention has focused mainly on key
  relatives and specific interventions with
  siblings have been largely neglected

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Research with SiblingsCoping with First Episode
Psychosis(Fisher and Steele, 2004)

• Alterations in their relationship with the
  affected sibling and other relatives
• Adverse impact on emotional well being
• Neglect of personal needs
• Difficulties in maintaining friendships
• Decreased academic performance
• Increased responsibility at home
• Ignored by psychiatric services
• Low awareness of genetic vulnerability
• High levels of involvement in caring for the
  affected sibling
• Finding is discrepant from published accounts of
  individuals with siblings with a chronic
  psychotic illness

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What is the likelihood of siblings coping with
early psychosis?

• 60-70 of first episode individuals live with
  families
• Mean age of onset for psychosis is 21 years, mean
  age for leaving family home is 23 years
• Adolescent age of onset from 14 means many
  siblings are likely to still be at home

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Worcestershire EI Service Siblings Audit (based
on caseload of n66)

• 59 (89) had siblings
• Total siblings 113
• Under 10 years 5 (4.4)
• 10-14 years 11 (9.7)
• 15-18 years 20 (17.7)
• 19 years 77 (68)

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Common Sibling Experiences

• Siblings struggle with the changes they observe
  in their brother or sister or their relationship
• Siblings lack knowledge and experience and can
  find it very difficult, distressing and
  frightening at times when someone in the family
  is psychotic
• Siblings may feel their parents are preoccupied
  and they do not get as much attention as the
  person who is psychotic
• Siblings feel for the sibling who is unwell
• Siblings may have anxieties about their own
  mental health and risk for psychosis
• Siblings rarely get information or support from
  services

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Common Losses Experienced by Siblings

• loss of freedom to enjoy pursuits with peers and
  an increased sense of responsibility
• loss of opportunity to develop friendships and
  interests due to being too preoccupied, busy,
  guilty or embarrassed about their situation
• loss of the relationship with their sibling with
  psychosis and age/role reversal
• loss of own identity and self-esteem
• loss of educational/career opportunities and
  freedom to make independent life choices /plans
• loss of attention from parents
• Loss/disruptions to family life and functioning

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Common Feelings Expressed by siblings (Canadian
Mental Health Association, 2005)

• Uncertainty, lack of understanding and
  helplessness
• Family tensions and disruptions to family life
• A range of emotions including fear, anxiety,
  guilt, anger, stigma, embarrassment, envy,
  resentment, loss and sadness
• Sense of burden and responsibility for their
  affected sibling

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Therapeutic Interventions with Siblings

• Few models within the research literature (most
• developed in physical health and learning
  disability)
• Support groups
• Information leaflets
• Activity camps/short breaks
• Personal stories
• Therapeutic board games
• Peer sibling support
• Family intervention

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Rethink Siblings Survey (n264) December 2006

• Majority rated access to advice and support as
  inadequate
• On what happens after parents are no longer
  around (89)
• On how relatives illness affects siblings at
  different stages of their lives (89)
• On relationships with service users (81)
• On the impact of mental illness on the family as
  a whole (81)
• On dealing with stigma (79)
• About genetics and mental illness (76)

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Rethink Sibling Survey (n264)December 2006

• Service requirements
• Accessible information sibling oriented
  information packs (84), dedicated sibling
  website space (76), publications by service
  users on how they could be supported by siblings
  (77)
• Active involvement sibling newsletter (65), web
  based chat rooms/ discussion forums (63)
• Direct contact with other siblings local support
  group or siblings network(53)

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Useful Websites

• Sibs www.sibs.org.uk
• Generic website for siblings producing
  information sheets, regular newsletter, will take
  cals from siblings, runs workshops
• Sib-Links
• New national network for siblings to share
  experiences and get support being set up by
  Rethink
• www.champsworldwide.com
• For children aged 5-12yrs who have an adult
  family member with a mental illness

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Useful resources

• Young People and Early Psychosis Intervention
  (YPPI) Centre (2002) For brothers and sisters,
  information about psychosis Written by Kristine
  Horn and edited by Deb Howe, Australia
• South Worcestershire Early intervention Service
  (2003) Information about psychosis for brothers
  and sisters Adapted by Caroline Maynard and Jo
  Smith, UK
• Canadian Mental Health Association(2005) A
  siblings guide to psychosis information, ideas
  and resources. Prepared by Sharon Mulder and
  Elizabeth Lines
• WFSAD (2001) Leave my stuff alone- a story for
  young teen siblings Written by Diane Froggatt,
  Canada

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• Psychosis in the family can be like a big cloud.
  It can be overwhelming. You think your family
  will never be the same
• 
  CMHA (2005)