INTRODUCTION

Introduction to the issue “Families facing a loved one’s illness”

Irma Morosini^*, Almudena Sanahuja^**  Margaux Bouteloup***

The theme for this issue deals with the processes families go through when facing the reality of a loved one’s illness.

The illness process itself involves complex situations that begin with the first symptoms, followed by tests, until a diagnosis is obtained. Certain situations – from the announcement of the diagnosis – can mobilize fears, and partially shared psychic pain can hinder the present and possible the future. Indeed, the family, paralyzed in a space of frozen time, assumes a certain degree of responsibility for the levels of dependency caused by the illness. They may be overwhelmed by feelings of guilt, helplessness, and hostility, and seek distancing and/or overprotection.

The paths that follow with treatments, steps forward and setbacks with a body that responds or not to that treatment, allow or complicate facing the process in the search for a cure, as it requires a family that accompanies, sustains, encourages, and supports. There are families that can do it and others that cannot; there are members who take charge and others who do not tolerate the idea and effects of an illness that worsens and invalidates.

From the potentially traumatic effects of the news of the diagnostic, the family is forced to adapt, which continues for the duration of a serious psychic and/or somatic illness of a family member. Physical illness affects the psyche and vice versa and can imply the disability of that family member, which alters both their own organization and that of the family group.

The experience of illness concerns the patient’s subjectivity in their psychic functioning, their defense mechanisms, and their personal and family history. But it also concerns their family. Childhood anxieties, beliefs, attachment patterns, and their place in the family-social environment are mobilized. The meaning given to the illness will depend on the conscious and unconscious factors involved, some of which originate in family history. In this process, the mentalization capacities of both the patient and the family group will be resorted to, which will influence the ability to process and manage the psychic and somatic pain that the illness can generate for each subjectivity and for the family. The process affects the patient and mobilizes the family, disturbing the group’s homeostasis, generating movements of regression and fusion, and the risk of the sick person being rejected for fear that the integrity of the family group will be affected and broken. When a family wants support to face these processes and help the patient, a therapeutic framework is necessary.

The family group thus has a space for listening. Indeed, family caregivers are at the center of public health issues, as caring for a seriously ill group member requires special energy and disposition. Caring for the caregiver is also a task that deserves reflection. The therapeutic space allows group members to express their feelings, clarify doubts, listen to each other, and confront positions, fantasies, and availabilities, with the therapeutic idea of strengthening themselves as a support network contained by the therapeutic team. Psychoanalytic listening and attention to the reactivation of attachment, mentalization, reflexivity, and associativity will support these processes in TFP work.

The article by Delphine Peyrat-Apicella and Romuald Jean-Dit-Pannel, «Irruptions d’interruptions involontaires de vie: résurgences traumatiques, maladie somatique grave et résonances périnatales», highlights, with the help of a clinical case, how a severe illness like cancer can hinder the family support provided to the sick member, who, due to their psychic fragility, relives family experiences of loss. This untreated past suffering generates aggression from the sick person towards the family, thus keeping them at a distance. From this phenomenon, the authors examine the neuroses of family destinies, relying on bodily-somatic challenges where the individual body carries that of the family and its unthought traumatic processes, of what can manifest as a symptom, bodily, somatically, generating one or several somatic decompensations due to economic overflow.

The article written by Cristina Calarasanu, «Once upon a time there was a child… or not? Urgency and the emergence of time in psychoanalytic family psychotherapy», shows how two dimensions of time, urgency and emergency, interact and, based on a clinical case that recounts the effects on a family of the announcement of an imminent “death” diagnosis at the birth of their child, three years prior, the author illustrates how the therapeutic space becomes a unique temporal field where past, present, and future intersect, allowing families to reconstruct narratives and develop a new rhythm of life.

L’article de Christopher Vincent «Couple psychotherapy in the shadow of illness» explore l’impact de la maladie sur le sujet mais également sur la relation de couple dans une perspective psychanalytique. Il expose les théorisations de Frank autour de la narration et de Toombs autour de la phénoménologie de la maladie d’un point de vue individuel et propose d’appliquer ces deux théories à l’objet couple. À partir de deux situations cliniques, l’auteur expose la façon dont le couple fait face à une maladie grave d’un de ses membres, dont il gère la perte et les réajustements imposées par la maladie et la façon dont les défenses individuelles et couplales vont être mobilisées durant cette épreuve et lors de la thérapie de couple.

Alberto Treyssac’s article, «Talleres psicoterapéuticos con familias de pacientes internados»,describes the work he carries out with the families of patients hospitalized for moderate to severe mental disability and other associated organic pathologies. The patients are admitted to a Home with a Day Center, where families have decided to opt for hospitalization as they are unable to meet their children’s needs. The various reasons for this decision, the difficulties suffered by the family, and the need to share and rely on the institution by forming networks with other families with whom they form a new group are presented. In the multi-family workshops, they have expressed their experiences, feelings, frustrations, and helplessness in the face of social silence. The author emphasizes the importance of building a sibling network, as they are the ones who continue to provide support after the parents’ passing.

The article by Manon Gibault, Magalie Bonnet, and Almudena Sanahuja, «L’enveloppe psychique familiale à l’épreuve du cancer», examines the effects of serious illness on the family group and its group psychic envelope. Through family projective tools (projective genography and spatiography), the authors illustrate how cancer affects not only the individual but also the couple and the family body over the long term, re-examining the balance and dynamics – between isomorphy and homomorphy – established before the illness. Based on a clinical family case study, the authors illustrate how the family psychic envelope is significantly affected by the ordeal of cancer, both in its function of protection against external excitations and in its function of receptivity to integrate the traumatic experiences experienced by the family.

The article by Liz Slater, Caroline Finill, Patsy Ryz, and Wayne Bodkin, «Living with illness in the couple: Clinical reflections from a Special Interest Group » presents the fruitful work underway within their Special Interest Group for the study of illness, the couple, and couple therapy, a clinical practice that requires the creation of specific spaces for thought. The SIG is presented by the participants as a personal experience within a clinical context. The objective of this SIG is to share clinical material and to develop both an emotional and theoretical understanding of the complex situations encountered by each therapist. Based on the exploration of four themes – dementia, suicide, therapist vulnerability, societal context, and the interface between clinical experience and personal experience – the authors illustrate how this framework becomes a space for containment and creativity, both personal and professional, for each of them.

Fernando Da Silveira’s article, «The metapsychology of the third kind and the clinic of the cure-type: The care of a young adult with mental Illness in the family» , highlights an original care proposal for an adolescent with a psychic illness who can resort to contemporary psychoanalytic clinical practice. A practice whose postulate is that the psyche is an extension beyond the intrapsychic, where the narcissistic foundations of being are anchored in metapsychic and metasocial supports, and that, therefore, the collapse of these supports endangers the subject’s very psychic existence. To ensure the success of the analytical work, this care proposal involves the implementation of different multi-subjective support spaces for the adolescent’s intrapsychic space, such as psychological, family, community, and social support networks.

In the Off-Topic section, Jill Scharff presents an interesting article titled «Difficult Brief Therapy with a Chinese Couple», a process carried out with a couple, proposing a novel and unusual approach: two therapists, including an interpreter, work for a short period of 5 sessions. This is a couple belonging to a culture with different patterns and norms. The couple is in treatment with one of the therapists and agrees to participate in this proposal, hoping for quick resolutions. The presentation is exhaustive, using textual sessions to illustrate the dynamics in this type of care, which allows us to see mechanisms that influence and define a closure that was not the one that was sought. The clinical experience allows us to learn from difficult situations and processes that can be truncated, although it also poses a difficulty in the thought process of one of the couple’s members, which further complicates the approach and tends to obstruct the process.

In the dictionary section, Jean-Pierre Caillot has sent us Paul-Claude Racamier’s concept of «L’incestuel» to review its scope, and he accompanies it with the history of the term, the issues that arose in relation to the concept, and the importance they displayed by allowing a deeper understanding of aspects of clinical manifestations in patients and their families.

In the Reading Notes section, we can read reviews of books and a film.

Martha Doniach reviews the book written by Perrine Moran in 2025, titled Love Songs: Listening to couples, where she describes how Perrine creatively articulates her background in arts and letters, highlighting the place of music from intrauterine life to later relationships, particularly couple relationships, using illustrations from love songs. Clinical work and art intertwine in this work by its author. Doniach’s presentation makes one want to read Perrine Moran in her entirety and shows how the author, with her knowledge and clinical practice, displays a high academic level that is enhanced by the demonstration of exquisite sensitivity.

Margaux Bouteloup writes about the work (book and film) My Sister’s Keeper – Jodi Picoult (2007),” where she highlights: on the one hand, a “taboo” issue, that of the “savior sibling,” specifically conceived to occupy a place within her family, that of saving from death to keep a family member alive, in this case her sick sister, and on the other hand, all the family psychic challenges and those of the “savior” member who, as they grow up, rejects that place, confronting unconscious alliances and the narcissistic contract to move towards their own autonomous decisions.

Another comment is the review offered by Nilton Bianchi on the book put together by Adriana Navarrete Bianchi and Paulina Zukerman, titled Psychoanalysis of Family and Couple: Latin American reflections from Editora Blucher, 2024. In this work, the authors present the work of the FEPAL Family and Couple Psychoanalysis Commission between 2022 and 2024. In the text, they address topics that interest and affect postmodern man in the challenges that concern his relational life and family in a historical-social context experiencing significant changes. It addresses the processes that make up couple and family psychoanalysis in the face of changes that allow one to think about new perspectives. The book is published in Spanish and Portuguese, which demonstrates the search for dissemination and understanding in a vast region that integrates Latin societies from America and Europe.

Ellen Jadeau’s book review of Monique Dupré la Tour’s work, À l’écoute du couple (2025), examines the construction of couple therapy, its journey, and its pitfalls in relation to societal developments, contemporary changes affecting it, and the institutions that comprise it. Different postures and attitudes depending on the context, profession, theoretical grounding, and demand are explored, illustrating the multiplicity of this clinical practice, which is similar to a group clinical practice. Whether the professional is a therapist, listener, or marital counselor, and whatever their theoretical grounding, the author invites them to reflect on the framework, contract, setup, and clinical positioning that drives them in their encounters with couples. It also addresses the distance, personal involvement, and lived experience of the professional, which raises the need for personal analytical work to listen to couples to limit the risk of entering into a form of confusion.

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* Graduate in Psychology (UBA). Psychodrama director. Specialist in Family and Couple Psychoanalysis. Lecturer at Universidad de Buenos Aires and Universidad Católica Argentina (undergraduate and postgraduate). Member of IAGP; AIPPF; AAPFyP. Member of the Editorial Committee and Editorial Secretariat of the Revue Psychanalyse & Intersubjectivité. Director of the Revue de l’Association Internationale de Psychanalyse de Couple et de Famille. Former member of the Board of Directors and Vice-President of the AIPPF (Spanish language). Author of the book Clínica de la Terapéutica Familiar, EAE, 2020. irmamorosini@hotmail.com; ilmorosini@gmail.com

** Professor of clinical psychology and psychopathology, psychology laboratory (EA 3188), Université de Franche-Comté; family psychotherapist and clinical psychologist. maria.sanahuja@univ-fcomte.fr

*** Clinical psychologist, Senior lecturer in clinical psychology, psychology laboratory (EA 3188), Université de Franche-Comté; scientific associate, Université de Genève. margaux.bouteloup@univ-fcomte.fr