Addressing Chronic Illness
in Psychotherapy with Your Clients

The Center for Disease Control states that 6 in 10 Americans have a chronic illness. Chronic, meaning the illness does not go away; it is there for the long haul.  So, the chances of you seeing a client with a chronic health condition is likely. I am one of these individuals; I’ve lived with a chronic illness since the tender age of 15, so I speak from a very personal perspective as well as a professional one.

In my private practice, I see clients who live, struggle, and thrive with various illnesses, and I have learned much over the years about how chronic conditions affect peoples’ lives. Illnesses such as heart disease, diabetes, Crohn’s, kidney, arthritis, and various other conditions come with their own challenges. There are treatments, but no cures.

From the time a person is diagnosed until the time he or she takes a final breath, each person with chronic illness lives with the diagnosis, the side-effects, and the co-occurring mental health conditions, such as depression, that can occur, and exacerbate, living with a chronic health condition

Chronic medical conditions also increase the chances of having depression and anxiety, as these conditions add many stressors to a person’s life. Stressors include navigating the healthcare system, diet, doctor’s appointments, medication management, body image, insurance issues, tests, work, disability, sex life, economic adjustments, and the shifting sense of identity that can occur along with the ups and downs and contradictions of life with a chronic illness.

So, what do I think therapists should understand when working with a client with a chronic health condition?

The following are some of the questions that can be looked at in therapy:

• What aspects of the client’s life are affected by chronic illness?
• How much of their day-to-day life is taken up by illness?
• What areas of the client’s life give them joy?
• Do they have a support system in place?
• Does their illness allow them to work and if not, what kinds of work would they enjoy doing?
• Do they experience pain?
• How old were they when they received his or her diagnosis?
• Does their illness affect their moods? If so, how?
• What are the biggest challenges they face?
• What do they fear and what are they hopeful about?

These are just a few of the questions that can be explored in therapy.

A therapist must also become familiar with their own countertransference around the subject of illness and mortality. Because we still live in a culture that values health over sickness and shies away from discussions about illness and death, we sometimes never get a chance to look at our own reactions to the subject.

To that end, I’ve included some questions you might want to contemplate on your own or in supervision or consultation. The following questions are important to explore—and you might even want to journal about them.

As an art therapist, I believe strongly in the creative process—and journaling is one way to have a deeper understanding of our feelings and work with clients, with no client names mentioned, of course!

Here are some questions to ponder:

• Does the idea of illness bring up any countertransference for me?
• Can I openly explore how the illness affects the client’s life and mental health?
• Do physical signs such as hair loss, tremors, scars, speech difficulties, etc., affect how I work with a client?
• Would I be open to going to a client’s home or using Tele-Therapy if they are not up to coming in?
• Do I shudder at discussing blood, needles and hospitals?
• What is my reaction to talking about death?

Why is it important to explore these questions? As with any population that is marginalized and stigmatized, having an understanding of, and knowledge about, the challenges these clients face can only enhance the therapeutic relationship.

I see chronic illness as being on a spectrum; the client might come to you in the midst of a physical and/or emotional flare up such as fatigue, pain, and hopelessness or the illness might be stable with fewer physical and emotional symptoms. The client might also be living with more than one illness that includes many symptoms or they might be functioning well with few or no symptoms? But, even during times of stability, clients face uncertainty.

Whether a client is newly diagnosed or has lived with an illness for a long time, it is likely their mental health has been affected. Learning to find a new sense of normal among our culture’s stigmatization of the “sick,” only adds to the stressors.

One of the constant challenges that can plague clients is finding a strong sense of self. There is the “sick self,” and the “well self,” and, the so-called “normal self” that existed prior to the diagnosis. Many times, these “selves” create identity confusion, as the client struggles to embrace a true sense of self. There are days spent in bed and days functioning, or days that fall somewhere in-between.

Developing a healthy identity can be challenging especially with daily limitations. The chronic illness wears and tears at the core self. A client might ask, “Am I damaged or whole?” The therapist and client can then explore the aspect of feeling whole when living with an illness.

Can you imagine asking a client to do a pie chart diagram that shows how much of the pie the illness takes up? This exercise can give the therapist a clearer understanding of what a client feels in relationship to the illness. Additionally, having the client fill in the areas and space that happiness and fulfillment take up can help the client explore and visualize other areas of their lives they may have forgotten about. This exercise can help clients see themselves as whole rather than damaged and lacking a healthy sense of self.

Victoria Van Zandt, LMFT, Art Therapist, is in private practice in West LA where she works with clients with chronic illness, career and life transitions, and those who identify as emotionally intense. In her bi-monthly Creativity 4 Women Workshops, Victoria helps women access their creative spirits, decrease anxiety and depression, and promote calm and joy. Learn more about how Victoria focuses on empowering women, whether coupled or single, young or middle aged at www.ArtTherapyLA.com and www.LAWomensTherapy.com.