Chapter 1: Interpersonal challenges

Longstanding family issues

The grief expert says
Chris MacKinnon provides guidance on navigating longstanding family issues.(3:22)Video transcript
Dr. Chris MacKinnon provides guidance on navigating an estranged family member returning at end of life. (3:22)Video transcript
Chris MacKinnon provides guidance on for managing family members who "parachute" in and want to change the care plan.(3:22)Video transcript

When responding to a call, you may be walking into longstanding issues and conflict. Many families have secrets, episodes of betrayal, painful disappointments and misunderstandings. Although you can never fully know the family’s history, you might sense it if you encounter a reaction that doesn’t match the situation. Old conflicts may surface when family members disagree. These prompts might help contain friction: 

Conversation Prompts

I know you’re both upset with each other. There will be time to deal with this later. Now is not the time to fight.

When you look back on this time five years from now, how do you want to remember it?

Some families may be open with you about their past challenges. Remember, this is a privilege and may be a sign you’ve gained the family’s trust. Keep in mind you’re not a therapist and your focus is to provide palliative care. It’s okay to remind families you’re not there to resolve longstanding issues.

Conversation Prompts

I’m sorry to hear how difficult things have been for so long. Thank you for trusting me with that information. These difficulties are beyond what I can help you with, but I can suggest some resources that may help.

Estrangement and parachuting

A common challenge occurs when an out-of-town or out-of-touch family member “parachutes” in and begins questioning decisions made by the family who’ve been providing the care. When an estranged family member re-enters the picture, this can create tension in the family dynamic and may require you to spend some time providing information to this person. (Sometimes there is one family member who is better able than others to communicate with the estranged person.)