Coping with spinal cord injury: the family perspective.

Little attention has been paid in the literature to the special needs of family members in dealing with the sudden trauma of spinal cord injury and the long-term implications of rehabilitation. Families are often encouraged to participate in rehabilitation plans that do not take their own developmental needs into account. As a result, developmental stresses occur, often expressed as a medical crisis for the spinal cord injured patient. Requests for psychiatric consultation are a frequent initial response of the medical staff to such crisis. Two clinical cases are presented to illustrate this process. Emphasis is placed on family aspects of the cases. Data from family interviews and home visits are used to illustrate the central themes that emerged during consultations. In particular, the data illustrate how family efforts to cope with the needs of their spinal cord injured member have caused them to place inappropriate emphasis on short-term stability of family life, sacrificing, in the process, long-term growth. Recommendations are made regarding the role of the consultation-liaison psychiatrist in the use of this family developmental approach.