Therapy for Siblings
Below, siblings share their thoughts on therapy and counseling.
Be sure to scroll down and read the thoughts of two psychosocial professionals with extensive experience in this area. They shared their expertise to help siblings and families receive this invaluable resource in a safe, supportive and barrier-free way.
“I wasn’t able to focus on schoolwork because all I could think about was my sister. Because of this, I was sent to a counselor at the school. She helped me with my schoolwork and took the time to talk to me about my sister since no one else was really around to listen.”
- SuperSib Holly
“My parents had me see a therapist, where I could pour out my feelings. She let me do art therapy, which was another way to express how I was feeling. Siblings need to have someone to trust to talk about their feelings and emotions surrounding having a brother or sister with cancer.
- SuperSib Rebecca
When I first heard the news, anger, sadness and fear overwhelmed my every thought. I insisted it was a type of punishment, and quickly blamed it on myself. I felt emotionally drained to the core.”
-SuperSib Danielle
If I could go back and change my actions during this period in my life, I would have told someone how scared I was. I can only imagine how much better I would have felt, knowing that I wasn’t alone and that someone was there for me to lean on.”
-SuperSib Courtney
Therapy can be an emotional lifeline resource for siblings of children with cancer. SuperSibs! asked two psychosocial professionals with extensive experience in this area to share their expertise to help siblings and families receive this invaluable resource in a safe, supportive and barrier-free way.
Our expert contributors are:
Lin Ewing, PhD, RN
Assistant Professor, Psychiatry, Psychology, and Pediatrics
University of Pittsburgh Medical Center
Pittsburgh, PA
Victoria Lachmann, MS, LCPC, CADC
VBL Counseling Services
Schaumburg, IL
Melanie Goldish, MA
Founder and Executive Director of SuperSibs!
Mother of a SuperSib and a SuperSurvivor
Comments are noted as LE (Ewing), VL (Lachmann) and MG (Goldish)
Why therapy for siblings of children with cancer?
How do I find a therapist for my child (or separate therapists for each of my children)?
How do I pay for therapy for the siblings?
Why therapy for siblings of children with cancer?
LE: There is an enormous amount of change and disruption suddenly occurring to the family’s routine as a result of a pediatric cancer diagnosis. Some children cope very well with this challenge and have a good support system with friends, family, and teachers, in addition to being effective communicators themselves. Other children don’t necessarily have those skills and supports, often placing them at greater risk for not getting important emotional needs met at a very scary time in the life of their family. Family therapy sessions are an important consideration, in addition to individual therapy support for each sibling. Every family dynamic is different -- but it’s vital to know that family and sibling therapy is available – and a combination of both can be extremely helpful.
VL: Seeking therapy is an act of courage... not a weakness. We're not born knowing how to deal with the emotional fallout of experiencing cancer in the family. And no one can go "alone into a room, have a 'good talking-to' with themselves, and come out 'fixed'". Most often, my role as a therapist is that of "tour guide"... helping the parent, teen and/or child most effectively understand, find choices and make decisions to allow them maximum peace of mind and hopefully, joy.
When a loved one is in discomfort, we are socialized to turn to family for solace. We expect to be able to turn first to family for understanding, time and ongoing attention. We long to have our feelings heard and validated. However, with siblings of children with cancer, there’s a particularly poignant paradox: For the exact reason that family are our "loved ones", siblings often feel that their parents (or other family members or caregivers) are also the very people who are difficult to approach. Siblings may feel as if they are adding to an already heavy family burden; they may feel that adults' lack of openness communicates a nonverbal message against their opening up discussion; and often an understandably overstressed parent has openly implied that the sibling needs to "stay strong/good/silent/grateful”. Siblings often feel that it’s “not ok” to show or express how they truly feel… and keep this bottled up inside.
Therapists and therapy are not meant to replace the irreplaceable role of loving family...and I make this distinction very clear to parents. Nothing comes close to the profound importance of family. Rather, therapy plays a very different role: Giving children, teens and adults a safe and non-judgmental objective place to identify, express, understand and embrace their emotions -- learning to accept, rather than fear, that their feelings are somehow “wrong.” An unbiased professional (the therapist) can legitimize the notion that feelings shouldn't be termed "right or wrong". Feelings are like matter or energy: They can neither be created nor destroyed. They are what lead us to connectedness and intimacy with others. If siblings are (or learn to be) fearful of their emotions at this extremely challenging time, they may repress, act out, or integrate other maladaptive coping strategies that can hinder them over the course of their lives. Early therapy intervention that simply provides this safe place to explore and validate feelings can lead to what these siblings desire and deserve: the opportunity to face a hopeful future with a new understanding of how to use this experience positively going forward. Going to a therapist does NOT mean that parents are somehow "falling down on the job". Rather, seeing a counselor is an important part of cancer treatment for the whole family... and will hopefully help lighten their load and ease their way into each day forward.
How do I find a therapist for my child (or separate therapists for each of my children)?
LE: First, ask the oncologist, psychologist, social worker, or child life specialist on the treatment team for recommendations. If they are not able to refer you to therapy support professionals to meet your needs, organizations such as your local Candlelighters chapter may be able to do so. Also, check with the guidance counselor or social worker at your child’s school. They usually know the providers in your community and whether they have the appropriate skills to work with this situation.
VL: Also, it’s important to note that professional and licensure agencies have a list of professionals who are licensed. (Licensure is important to ensure that you’re receiving certified professional support.)
If your family has insurance (PPO, HMO or point of service plan), therapists are often listed on-line by the insurance company, and most will list therapists’ specialties and areas of expertise. These resources are often listed as "outpatient mental health counselors." Look for therapists using words like: catastrophic health, health trauma, medical rehab, hospice or end-of-life (as appropriate); in their list of specialties. Many therapists are listed in the Yellow Pages, as well. Simply call your insurance plan’s customer service number (usually found on the back of your insurance card), and the support representative can help refer your family to one ore more counselors nearest you, with expertise to meet your family’s needs.
Also, when your child is discharged from the hospital, you should receive a discharge plan that includes social service recommendations. If this is not provided to you, please ask for it! Your oncology social worker can help connect your family with services -- including excellent resources that are either free or offered on a sliding scale).
MG: We know you’re juggling SO much right now! But this is a really important resource for your SuperSibs! kids (and you, as well)… sooner rather than later. You may wish to call and talk with one or more therapists to see which professional(s) feel right for your child’s (or family’s) needs. Therapy is nothing to be ashamed of… everyone in the family deserves the right to be heard and supported to help manage through this extraordinarily difficult time.
What will therapy accomplish?
LE: Since each child, family and situation is unique, your experience may include: reassurance that what your child/family is experiencing/feeling is normal, given this situation; other information about how the psychological experiences relate to the events that are occurring); specific intervention for depression, anxiety and/or stress, if present; referrals to other community resources, if needed; an objective perspective; recommendations of how to enhance coping and lead to healthy adaptation and outcomes.
Depending on the presenting issues and goals of the therapy, remember that it can take a while to see results. Therapy often does not yield rapid change, but rather, consistent improvement in coping and functioning over time. When in crisis, we want and need to have relief, and going to therapy is an important step in that direction. Some of this relief will come just with making the call and having an initial session, but most gains and improvement will come with consistent therapy over time.
VL: Given this tremendously challenging experience, emotional recovery may take years of support (and in some ways, continues throughout the rest of ones' life). Emotional recovery and grief is different for everyone... it’s a sporadic process... and timeframes shouldn't be imposed nor strictly anticipated. Therapy will help create safety and permission for the child and parent to own, understand and work with their feelings – to "be in the driver's seat" of their lives, without being hindered by unresolved issues. Therapy will help each individual be an active, thoughtful planner of their life going forward.
MG: Are you asking yourself, “Is this REALLY worth the time, energy (and possible expense)? Do MY children really need this support?” We say YES! We hear from siblings and parents time and again that therapy helped them to express their feelings (like fear, anger, hope, stress, love, distress, strength, guilt, grief, sadness, determination,etc.) in a powerful new way. Siblings learned ways to manage through the emotions and feelings that otherwise continually deplete energy, focus, relatinships and self esteem. The cancer journey IS scary – for everyone in the family. These therapists and counselors can help make this a more manageable journey… and help equip us for whatever challenges lie ahead in our lives “post-cancer”, too.
How do I pay for therapy for the siblings?
LE: Depending on the provider, this mental health service for siblings (and for family therapy) is often covered through your insurance. If insurance is not an option, there may be other resources in your community that are free, such as support groups through the oncology department where treatment is occurring, or through other agencies (like Wellness House in Chicago, Gilda’s Clubs, Candlelighters, SibShops or others) that your oncology team members can recommend. Make sure you ASK your oncology team what other options are available!
Also, some therapists are willing to adjust fees and/or allow the family to extend payments over time. Some therapists are able to do this, and others are not. Do inquire if this is an option.
VL: Most families have some type of insurance benefits to help with this. Even "out of network" coverage usually provides some amount of payment to pay for an out of network counselor, if that is required. Also, Medicare and Medicaid pay for mental health services.
The law requires that even those without insurance (or those whose coverage is so limited or expensive that this benefit is prohibitive) are entitled to access mental health services via local mental health clinics. In Illinois, for example, every resident of the state is able to go to the local mental health clinic in their area and be provided services in a timely manner on a fee scale that slides down to zero... depending on need and ability to pay. These services include everything from one-on-one counseling, to psychiatric care, to social service advice, to support groups or referral to groups. This care is most often excellent... parents needn't be fearful that these are second rate services.
If not a therapist, what other support professionals or organizations are available for sibling’s psychosocial support?
LE: Organized resources are different in each community. Often, by letting significant others in the siblings’ life know what is happening for the family, additional informal support can be identified (teachers, school counselors, clergy, coaches, girl scout/boy scout leaders, religious/spiritual leaders, parents of their child’s good friends, any adult that is regularly part of the child’s life).
VL: Effective counseling support is also offered through non-profit organizations like Jewish Family Services, Catholic Charities, and Salvation Army, for example. All have counseling centers that employ excellent workers. Bottom line: Every sibling and family deserves and should be able to find services tailored to their need, given the information and options to access this support.
MG: Most importantly, please remember that when a child is diagnosed with cancer, everyone in the family is affected. We hope this information helps your family to receive caring, professional, helpful support – so your SuperSibs! children and teens (actually, your whole family) can face the future with strength, courage and hope.