One of the specialty services offered at Lindsey Hoskins & Associates is Medical Family Therapy, a specific type of couple and family therapy offered to those struggling with an unexpected, challenging, or complicated medical diagnosis or situation. Medical family therapy can help clients communicate collaboratively and productively with their medical team, make sense of complex medical information, and make decisions about treatment or care. Additionally, we can help couples and families work together to manage the demands of their diagnoses in a way that is inclusive of everyone’s perspectives, helping facilitate healthy communication and support. Lindsey Hoskins is specially trained to provide Medical Family Therapy services, having complete an intensive MedFT training program in 2006. Lindsey is able to provide medical family therapy services for the full range of medical conditions, and is especially knowledgeable about hereditary health conditions (those that are passed from generation to generation through inherited genetic mutations).

Below are several examples of the types of clients who might benefit from medical family therapy services at Lindsey Hoskins & Associates.

Danica initiated individual therapy after she learned that she had tested positive for a BRCA mutation. At age 23, she was five years away from the age at which her own mother was diagnosed with breast cancer, which happened when Danica was only three years old. Her perceived risk of breast cancer was very high, and she was having trouble managing her risk-related anxiety. Danica’s doctors were not as responsive to her concerns as she would have liked, telling her that at age 23 she was too young to begin intensive screening. This left her feeling helpless and increased her perception of risk. Danica was also worried about how her positive BRCA mutation test would impact her dating and social life. As a single woman, she looked forward to meeting an falling in love with the right guy; her mutation seemed like a significant barrier to forming and maintaining a healthy relationship. She was worried about how she would communicate with a future partner about the demands of her medical situation — the frequent screenings, waiting for test results, and likely eventuality of risk-reducing surgeries felt like a burden she’d feel guilty about bringing into a relationship.

We would help someone like Danica in several ways. First, we would help Danica identify and communicate with a doctor who was a better fit for her needs. We would help her understand what both her short- and long-term cancer risks were, and find a doctor who understood that because of her mom’s age at diagnosis, she was not a typical 23-year-old mutation carrier and needed to be screened earlier. We would discuss how to be an educated and empowered consumer of healthcare services, and advocate to have her needs met in that setting. Next, we would work with Danica to imagine and set the stage for a relationship in which her mutation is accepted, and in which her mutation-specific needs are met. We would connect her with other young mutation carriers who have successfully established and maintained intimate relationships. We would help Danica map out a plan for medical management in the future, and realign her perspective around how this would impact a future relationship. Down the road, when Danica enters a significant couple relationship, we might work with Danica and her partner to facilitate healthy couple communication, support provision, and family/life planning.

Randy and Kate initiated couples therapy after learning that Randy’s mother had been diagnosed with Huntington’s Disease. Because Huntington’s Disease in transmitted in an autosomal dominant manner, Randy’s mom’s diagnosis means that he (along with all of his siblings and all of his mom’s siblings) is at 50% risk for having the disease himself. Huntington’s Disease is especially scary in that a positive genetic test for HD predicts with 100% certainty that an individual will develop the disease. Married for two years and getting ready to start a family, Randy and Kate faced a tough set of questions and decisions: Should Randy be tested for the genetic mutation that would put him at risk for HD? If he tested positive, how would their family formation plans be affected? How much of their experience did they want to share with Randy’s family, and with Kate’s? Should they secure life insurance before Randy undergoes testing?

We would help a couple like Randy and Kate in several important ways. First, we would help them deal with their grief over Randy’s mom’s diagnosis, and the eventual loss that it would bring to their lives. We would help them think through what they wanted their relationship with her to look like as her disease progressed, and what kind of support they were able to offer. Next, we would help Randy and Kate make a decision about whether Randy will undergo genetic testing to find out if he also carries the genetic mutation for HD. We would help them weigh the pros and cons of that decision on both sides, and come to a consensus that does the best job of meeting both of their needs. Whichever decision they made, we would help them to cope with its implications; this could take the form of living with the anxiety of not knowing, and how to keep that at a manageable level going forward. Or, if they did decide to undergo testing, we would support them by helping to identify the appropriate genetics professionals to facilitate the test, coping with the process of waiting for and receiving the results, and dealing with any grief and fear issues that surface when the results become available. We would work with them to discuss what changes they would need to make in their relationship to accommodate this new information, and how they could support and care for each other throughout the process and beyond. We would help them explore the role of each of their families in these processes, and how much of what was happening they wanted to share with their parents, siblings, grandparents, etc. Finally, we would help them make decisions about family formation. If they choose not to undergo testing, we would help them explore options including going forward with conventional family formation (getting pregnant naturally and not knowing whether resulting children were at risk for HD), or using a blind testing process to ensure that children would not inherit the mutation, without Randy having to undergo testing himself if he chose not to. If Randy did decide to be tested, we would help the couple explore all of their fertility options, including preimplantation genetic diagnosis (testing before establishment of pregnancy), prenatal diagnosis (testing after establishment of pregnancy), gamete donation, etc.

The Marzolo family initiated family therapy after Tim Marzolo, the patriarch of the family, was diagnosed with Alzheimer’s Disease. The family had been shocked by the diagnosis, and because Mr. Marzolo’s symptoms had come on suddenly and escalated quickly, they were having trouble making the necessary changes to their normal way of life. Mr. Marzolo and his wife, Cynthia, lived together in the family home. Their three adult children were spread across the US, all busily engaged in raising their own families and developing their careers. Cynthia wanted to continue to care for Tim in their home, but felt overwhelmed by the demands of his illness. She struggled to make sense of all of the information they were getting from the various doctors with whom they were interacting, and felt frustrated that some of her questions were not answered fully. She appreciated the help that her three children offered, but felt overwhelmed by their tendency to fly in for a long weekend and make sweeping changes. The family convened for an intensive weekend of family therapy in our offices.

We would work with the Marzolo family on several important goals. First, we would help the deal with their feelings of grief and loss around Tim’s diagnosis, and what it would eventually mean for them individually and as a family. We would help the three adult children and their spouses to understand how to best support their parents, and collaborate to work out the details of that support provision. We would help Cynthia to understand the complex medical and caretaking information that was being provided to her, and identify ways for her to get the most out of physician visits. We would assess the viability of home care, and identify appropriate supports to make that a reality if the family decided together that that was what they wanted to do (i.e., perhaps a day or night nurse would be helpful at some point). Finally, we would help Tim’s three children think through the possibility of a genetic component to Alzheimers, considering their own risk and whether/when they might want to pursue information about that.

Medical family therapy can be a powerful tool in learning how to manage, cope, and make decisions in complex medical situations. A diagnosis that is unexpected, scary, hereditary, or chronic is often difficult to manage, and a skilled Medical Family Therapist can be extremely helpful in navigating the new demands that come along with this.

Lindsey Hoskins & Associates provides Medical Family Therapy services in downtown Bethesda, MD. If Medical Family Therapy would be helpful for you, please contact us to set up an appointment by emailing [email protected], or by calling (301) 200-5290

Keywords: BRCA, Huntington’s Disease, Alzheimer’s Disease, HNPCC, Li-Fraumeni Syndrome, Cowden Syndrome, Lynch Syndrome, Familial Adenomatous Polyposis, Retinoblastoma, Wermer Syndrome, Von Hippel-Lindau Syndrome, Bloom’s Syndrome, Canavan Disease, Cystic Fibrosis, Fanconi Anemia, Gaucher Disease, Maple Syrup Urine Disease, Nemaline Myopathy, Spinal Muscular Atrophy, Tay Sachs Disease, Hereditary Breast Ovarian Cancer, Turner Syndrome, Sickle Cell Anemia, Hereditary Colon Cancer, Familial Testicular Cancer, Hereditary Cancer