Dealing with difficult families

Dr Elizabeth Hart shares examples of what difficult families may look like when facing a cancer diagnosis and ways to overcome these challenges.

When you’re diagnosed with cancer, it often feels like life stops. You have something new and overwhelming to deal with, and everything else becomes secondary. And that is how it should be; you and your health must become your top priority. You owe it to yourself and the people who care about you to get through this successfully. 

One of the things I coach people to do is create a supportive community around them. We know that statistically people with better support networks have better outcomes. However, what if you have a difficult family, and creating this support network isn’t that simple? 

Just because you have cancer doesn’t mean that tricky family circumstances suddenly sort themselves out and difficult family members change. The diagnosis itself is the crisis, but dysfunctional family dynamics can become the second crisis running alongside it. 

The most important thing to know is that no one should navigate this alone, and asking for help, especially when family dynamics make home feel unsafe or exhausting, is a sign of strength, not weakness. 

Difficult family dynamics

• Power imbalances, where you feel like you have no voice.
• Communication problems, where you feel unable to explain how you feel and be heard, or where there is stonewalling or silent treatment.
• Emotional dysfunction, where others in your family are emotionally unavailable.
• Role-based patterns, where you are a peacekeeper and need to manage  everyone else’s emotions.
• Toxic behaviours, like narcissism, manipulation, guilt-tripping, emotional blackmail, and gaslighting.
• Unresolved history, like generational trauma, unspoken grief or loss, and old grudges.
• External stressors, such as financial stress, addiction, mental illness, and divorce. 

How it may play out 

A cancer diagnosis often brings things that have been normalised over the years into sharp relief and forces you to look at things differently. This disrupts the family dynamics, causing resentments and resistance. 

Examples:

• When communication is broken: family members may avoid talking about the diagnosis, making you feel isolated and unsupported.
• When roles are rigid: if you have always been the caregiver, others struggle to reverse roles to provide support; a peacekeeper may downplay their own fear to keep the family calm.
• When there is favouritism or enmeshment: some family members receive more information than others, creating jealousy and conflict.
• When narcissistic dynamics are present: a narcissistic family member makes the diagnosis about themself, dismissing or minimising the patient’s needs. 
• When there is unresolved trauma or grief: old family wounds are opened, causing conflict.
• When financial stress exists: treatment costs and decisions around treatment choices can amplify existing financial tension.

Emotional distance

The emotional distance that can develop between family members may further complicate the healing process. Even when support is present, it might feel conditional or strained, making it difficult to fully rely on one another during a vulnerable time. You, as the patient,  may spend precious emotional and physical energy managing family conflict instead of healing. You may even feel guilty about being a burden. 

Finding solutions

One way to deal with a difficult family is to try and create new boundaries. Sit family members down and explain what you need and how they can best help you. You may need a family therapist or social worker to assist with this. Sometimes people just need guidance as to what they can do to best support you. 

However, if the situation is too difficult or fraught, it may be time to create a support network apart from your family. Close friends or colleagues may be easier because they  are not as emotionally involved. Otherwise, professional help may be necessary. Most cancer units have embedded social workers that specialise in these challenges. Patient navigators may be able to help co-ordinate care and connect you to resources. 

A trusted family medicine practitioner or GP is a valuable resource for assessing  the severity of the dysfunction, deciding if medication may be appropriate, and referring on to another professional if necessary. 

In-person or online support groups and major organisations like CANSA or BCNSA offer support and resources. 

You can also consult a cancer survivorship coach. Coaching is a collaboration between you and the coach, to help you find solutions and navigate the best way forward for your unique circumstances.

Dr Elizabeth Hart (M.B,Ch.B; FMCHC; NBC-HWC) is a qualified health coach, coaching clients with a wide variety of chronic conditions and life challenges to help them achieve optimal health and well-being. She is also a qualified emergency medicine practitioner and an integral member of a breast cancer unit, involved in surgical and survivorship roles.

Header image by Magnific